Forget A1C This New Test Is the Future of Diabetes

All right everyone, let me start with something that might sound controversial but it is absolutely true. A1c can look perfect while your blood sugar is doing damage every single day and if all you are looking at is A1c you are missing the big picture, the most important part of diabetes care. Today I'm going to explain why A1c is no longer enough and what the future of diabetes monitoring really looks like and why a newer way of tracking glucose is changing how we prevent complications. Make sure you stay until the end because I am also going to talk about the limitations of the technology which is continuous glucose monitoring, the mistakes people make with them and once a year implantable option that actually many people do not even know that exists. So let me tell you I'm Dr. Amit and you probably know me. I'm an endocrinologist specializing in diabetes, weight loss and hormones. I have over 2,000 videos in YouTube SugarMD, type SugarMD, search whatever you're searching for. You're going to find a video about weight loss, diabetes and other hormonal conditions. Now I practice in Port St. Lucie, Florida here, a mid-sized town in South Florida and it's getting pretty big actually. The largest, the fastest growing city in Florida right now but let's get into this. Why A1c is overrated as a standalone test? I'll tell you this, A1c is just an average and that's the problem. Averages hide extremes. You can have an A1c of 6.5 and still spike to 250 after meals. You can have an A1c of 6.5 and drop to 50 at night. A same number, just completely different risk and A1c does not tell me how high you spike after meals, how often you crash and interestingly even with the same average numbers different people can have different A1c numbers because the red blood cell lifespan is different from person to person and also you know the A1c doesn't really tell me how stress raises your glucose, how steroids and medications increase your glucose. Now it doesn't tell you either A1c has no idea about how sleep is affecting your blood sugar. It's just a snapshot, it's not a story and diabetes complications are caused by patterns, okay, not averages. Here's the sensational truth. Two patients, same A1c, one has smooth stable glucose all day and the other rides a glucose roller coaster. Only one of them is protected from nerve damage, heart disease and kidney disease and that difference does not show up on the A1c. Obviously if it is you know clearly like your A1c is 10% then okay that's a different story. That's really high you know I'm talking about A1c's in the six to seven range and some people are still getting damaged thinking that they're safe with that A1c. Now what actually predicts these complications better, right? This is where the future is already here. You call this time in range, meaning how often your glucose stays between 70 and 180. Not the average, the consistency. When glucose stays in range you get less oxidative stress, less inflammation, less vascular damage. Now flat glucose curves also protect your organs. Now the wild swings damage them. This is why continuous glucose monitoring has changed everything. Yeah they have limitations which we will talk about but why CGM is such a game changer, right? To begin with, a CGM does something that A1c never can. It shows cause and effect. You eat, you see the response. You walk, you see the response. You sleep poorly, you see the response. See it's a very good teacher. Patients finally understand their own metabolism and behavior changes a lot faster when feedback is instant. And this is powerful medicine. But let me be very clear about CGM limitations. I'm not saying CGMs are perfect. They're not. Anyone telling you otherwise is just trying to oversell you something. But let's talk about this honestly. Now false readings do happen a lot and CGMs, you know, as you know measure glucose in your interstitial fluid, not your blood. Now that means there is going to be a delay and there can be inaccuracies. Now rapid changes can look exaggerated also and compression can cause false lows. Like when you're sleeping on that sensor at night we call them compression lows, right? And dehydration can distort the readings too. So you must always correlate with symptoms. If CGM says you're 55 but if you feel perfectly fine, do a finger stick. CGM is a guide, not the gospel. Now pressure lows can be explained simply. This is very common. If you sleep on the sensor, the pressure reduces the local blood flow. The sensor thinks glucose is dropping but it's not. You wake up to an alarm. Your heart is racing. You're panicking that my blood sugar is not down to 30, 40, 50, whatever. Meanwhile your actually blood sugar is normal. That's not real hypoglycemia. It is just physics. Understanding this prevents the unnecessary fear and overtreatment and constantly eating at night. Try to bring your blood sugar up when it's not really down. CGM is a trend tool, not a single number tool. If you're looking at CGM one number at a time, you're missing the picture. One reading means nothing. Patterns means everything. This is where the education really matters. A lot of people get on these devices and it's like, I don't like this. Its numbers are not right. Well because nobody taught you how to use these devices. Without guidance people can misinterpret that data, can make bad decisions. But CGM without context really will just cause anxiety and some people just return it for that reason. They'll say, I don't want this. It's too much, too much alarm, too much information. But if it's used correctly it actually reduces it. So why A1C and CGM should work together? Well A1C still has value, right? But it should never be alone. Think of it like this way. A1C is a photograph and CGM is a movie. You need both. You need some snapshots and you sometimes need to watch the whole thing. Now let's talk about the future option that most people do not know about. This is where things get kind of interesting. I'm a proceduralist endocrinologist so I do procedures. I do thyroid radiofrequency ablation for benign nodules to shrink them non-surgically. We implant the Eversense 365 sensors as well because this is just once a year implantable glucose monitor and when I heard about it I'm like that's pretty cool because it's one sensor, one procedure and you have 12 months of data. You don't have to worry about failed sensors. You don't have to worry about inaccurate results and you have to worry about like inserting every other week, every 10 days and there are no constant sensor changes, right? So not a lot of adhesive issues and yes I personally do this a lot in my practice because people are tired of Dexcom and Libre giving them problems. Like I told you they're not perfect but Eversense, I'm not saying Eversense is perfect but still a whole lot better than Dexcom and Libre. Now this sensor is implanted under the skin and it uses a removable transmitter that stays on the skin. Now it vibrates for alerts instead of constant alarms which is a huge deal for a lot of patients. This is huge for people who have like skin reactions to the adhesives with the Dexcom and Libre or they hate changing sensors, they want long-term stability, they want better accuracy and consistency is strong here in the sensor because sometimes people will say well this sensor versus the other sensor with Dexcom they read differently and it is true. They're not always the same and calibration requirements are minimal with the Eversense and yes you do some calibrations occasionally but that really improves the accuracy. Now who are great candidates for Eversense? Well for sure people with type 1 diabetes, patients with type 2 diabetes on insulin, patients with severe glucose variability, severe lows, patients who want deeper insights without the constant hassle and yes you do not need to be on insulin to benefit necessarily. Now what I see in my practice when patients are using their CGM properly it's going to cause you know definitely lower their glucose variability, it's going to help reduce hypoglycemia, low blood sugars and improve the confidence in their management. They make smarter food choices and the biggest shift becomes awareness. You cannot really manage what you cannot see. Now if you are still managing diabetes based on A1c alone, you are practicing outdated care. Modern diabetes management is pattern recognition, not averages. The goal is boring blood sugar, flat, flat, predictable, stable and here's a practical takeaway. Ask about time and range. Ask about glucose variability. Ask whether CGM makes sense for you and understand its limitations. Use it intelligently because technology is a tool, not a replacement for a good judgment. Now A1c tells you where you have been. CGM tells you what's happening right now and what will happen soon and prevention happens in the present. If you want to learn more about the advanced diabetes monitoring, weight loss, hormone optimization, visit our website. We have two websites We are right here in Port St. Lucie, Florida in Treasure Coast. Thanks for watching and remember the goal is not perfect numbers. The goal is stable physiology. Talk to you later.