Study: Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes

Interesting read. Your thoughts?

Full download available at the top of the article.

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

Our objectives were to explore whether the phenomenon of HbA1c ‘tracking’ occurs in individuals with type 1 diabetes, how long after diagnosis does tracking take to stabilise, and whether there is an effect of sex and age at diagnosis on tracking.

In individuals with type 1 diabetes, glycaemic control measured by HbA1c settles onto a long-term ‘track’ and this occurs on average by 5 years following diagnosis. Age at diagnosis modifies both the rate at which individuals settle into their track and the absolute HbA1c tracking level for the next 10 years.

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tried reading the article. it gave me a headache. All I can say is that my A1c got better when I went onto a pump 20+ years ago after 18 years of MDI, and last year when I started using the Dexcom G5, I further reduced (and have maintained) a yet lower A1c. Studies can come up with just about any result that is desired and I have little patience in believing many of the studies. My wife worked with a doctor who would fudge the results of the study he was being paid for, and it’s a very common thing.

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I’m super new to this disease, but from the information and stories I’ve been going through, this thing is so personalized that I find widespread studies like this near useless. You have to do the work to figure out your own body and what works for you, then stick with it as much as possible.

To hear that after 5-10 years I’m just gonna be stuck at the same BS levels is ■■■■■■■■. (Unless I’m misinterpreting what the article’s conclusions were.)

The study doesn’t even mention CGMs so I guess the results could be useful as a very, very broad-brush finding. No so relevant for a more informed group like those at TuD. Still, much appreciated for posting this!

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Wow, people learn more about the disease within the first year of diagnosis than they do after they’ve had it 5 years. :roll_eyes:

This is silly stuff.

The greatest difference in mean HbA1c measurement (−7.0 [95% CI −8.0, −6.1] mmol/mol [0.6%]) was seen when comparing measurements made immediately after diagnosis (0–1 year since diagnosis) with those at 10 or more years (the reference category). The mean difference in HbA1c for the successive periods compared with 10 or more years after diagnosis declined and was no longer statistically significant after 5 years.

If this is true, my guess would be that it’s because most people (who aren’t part of sites like this one) give up and stop trying to improve their A1c because it’s impossible with the crappy advice they get from medical professionals and/or because they are told that their A1c is fine or the “best they can expect” even if it’s high.

A lot of people, including me at one time, think it’s impossible for someone with Type 1 to maintain an A1c in the non-diabetic range.

After 23 years, I brought my A1c from the 7-8 range to the low 6s by figuring out the combination of strategies that best worked for me. (And I’m hoping my A1c I’ll get this weekend may be in the 5s.)

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Hmmm … my uninformed guess is that if the study is just measuring the difference, then yes, it is probably true that after five years the difference is less. After all, if a diabetic is starting from a position of DKA and an A1C of 10%+, and they can get to the ADA recommended 7.0% in the first five years, then even if you can get to 5.5% in the next five, that’s a smaller difference …

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Yes, the difference is the key thing here. I can see why things don’t change much between 5-10 years, given this is a UK study, with the NHS at its core.
People go to free and probably over crowded clinics, pumps must be begged for, some clinics are giving the option of pump OR Libre/Dexcom, not both, and the standard sort of advice would likely be given. As in, eat this, inject this, and all will be well.
Only it isn’t, and we know why. Low carbing is immensely helpful, CGMS or Libre plus a pump is the standard of care we should all have the option of.
In Australia, the free Medicare system works much the same way. Some kids can get CGMS and pumps free, but only kids.
Freedom to choose the correct combination of technology and insulins have made my control improve enormously from the days of one injection a day and avoidance of any BSL testing. I’ve gone from the standard UK HbA1c of mid to high 8s, to less than 6. And I do not work especially hard at managing my D.
It is simply that I have chosen the right combination of “stuff” for me, and have had the freedom to do so (Private Health Fund in Australia, and a GP who prescribes what I ask).