Let’s face it the A1c can be one of the most anxiety provoking parts of treating and living with Diabetes. As a provider, if your patient’s A1c is above target, you may  have a few reactions: UGH!, What is going on?, What are they not doing?. A thought about non-compliance may cross your mind. Let’s sit on the  other side of the exam table. The person with Diabetes, is holding their breath waiting to hear that A1c. They are anxious that it is not what it should be. They are already reprimanding themselves for not doing better and fearful of what their provider will think and say. Something to consider: the A1c reflects 90 day average and does not tell the story of a recent change in medications or lifestyle.  Have you looked at the A1c in terms of improvement and not purely target? What is the target? (see graph below and check out this link:  https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes  ). Consider what contributed to the result the contributors to the result (illness, steroid therapy, inability to access medications, major life stress).   Give  positive feedback on their hard work on improvement.  Have you acknowledged that they may be disappointed in the result? Has an adjustment in therapy been considered. Be sure to have a conversation about ALL of these things. The A1c is complex, don’t view it as the end all and be all of Diabetes management and cannot be interpreted in a vacuum.  Remember, no one with Diabetes wants a high/above target A1c or to be “sick”.