The A1c Trap: When Numbers Take Center Stage

For decades, HbA1c, which is a measure of average blood glucose over the past three-or-so months, has been the ultimate marker of “good” diabetes management. It’s printed on lab reports, discussed in every appointment, and often used as a measure of success or failure. Add to this, percentages of Time In Range (TIR), and Time In Normoglycaemia (TING), along with Standard Deviation (SD) of blood glucose values, and we have a perfect sotrm of various metrics.

But here’s the thing: A1c et al. only tells part of the story.

It can’t show sleepless nights after stubborn highs. It doesn’t capture the mental gymnastics of counting carbs, managing stress, or fearing hypos. And it certainly doesn’t measure how a person feels living with diabetes day after day.

If we want to deliver better outcomes, we must look beyond A1c and realted metrics, and start listening to the people behind the numbers

Lived Experience Is Data, Too

In health care, we love measurable metrics. It makes an invisible condition more palpable, something to benchmark, relate to and (gasp!) even compare oneself with. But what about the unmeasured? Things like energy levels, quality of life, resilience, or the sense of doing well?

These aspects are more easily captured through Patient/Person-Reported Outcome Measures (PROMs) and Patient/Person-Reported Experience Measures (PREMs), in other words tools that quantify what truly matters to people living with the condition.

But beyond tools and surveys lies something even more powerful: lived experience.

As someone who’s lived with type 1 diabetes for almost four decades, I’ve seen how personal stories can reveal insights that numbers simply can’t. A lived experience lens helps us understand why a therapy isn’t working for that specific person, how routines fit into real life, and what support is needed to actually make care sustainable.

When we bring lived experience into clinical design, policymaking, and innovation, care becomes real-world ready

Why the System Still Leans on A1c

There are good reasons A1c became a global standard: it’s quantifiable, comparable, and clinically meaningful. But it’s also convenient. Yet, convenience can easily become complacency.

Health systems are often designed to reward what’s easy to measure, not necessarily what’s meaningful to measure. That’s where Value-Based Health Care (VBHC) can change the game.

VBHC shifts focus from volume to value, from “How much care was delivered?” to “Did it actually improve people’s lives?” And to answer that question, we need both data and dialogue.

Real Value Is Human Value

When lived experience guides care, everyone benefits:

• People with diabetes feel seen and supported, not judged by a number.
• Clinicians gain richer context to guide decisions and build trust.
• Systems and payers invest in interventions that create true quality of life improvements.

That’s not “soft” care. That’s smart care, making the whole value-chain of care more sustainable.

A Moment That Changed My Thinking

A few years ago, I was invited to review a hospital’s diabetes education program. Everything looked perfect on paper, with their excellent glycemic outcomes, detailed protocols, impressive graphs.

But when I spoke with people receiving care at this clinic, a pattern emerged:

“I understand the theory. I just can’t make it work in my daily life.”
“I feel guilty when my numbers aren’t perfect.”
“I wish someone would ask what success means to me.”

The gap between what’s measured and what’s meaningful is where we lose people, and casually label them “lost to follow up”. And it’s exactly where person-centered care must step in.

From Outcomes to Impact

Imagine if every diabetes clinic measured not just numbers and A1c’s, but also:

• Sleep quality and fatigue levels
• Confidence in self-management
• Emotional wellbeing
• Social participation and daily function

These dimensions of health are already used in progressive VBHC initiatives. They transform care from transactional to transformational, because they tell us whether care actually works in people’s lives.

Beyond A1c: A Call for Co-Creation

Moving beyond A1c isn’t about abandoning data, but rather about expanding it. It’s about pairing clinical evidence with human evidence. A match made in real-world management of a relentless condition.

The most innovative health care systems of the future will be those that co-create care with people, integrating lived experience as a cornerstone, not an afterthought.

Because in the end, A1c may show certain aspects of management, but lived experience shows meaning.

Join the Conversation

What’s one thing you wish your diabetes care team measured or asked about — beyond A1c?
Share your thoughts in the comments or connect with me on LinkedIn or Instagram @hannadiabetesexpert.

Let’s make diabetes care more human, together. 💙