There are forces in the UK that argue that targetting HbA1c below 7.5% is KILLING people (http://www.straightstatistics.org/article/how-overtreatment-diabetics-may-have-cost-lives). We however know better, we know the truth. The UKPDS showed that tighter blood sugar control reduced complications and we clearly advocate for tighter goals, better access to testing supplies, universal use of the basal bolus regime (please ban mixtard), better education with carb counting and DAFNE and better access to insulin pumps and CGMS.
Yes. I was at 9.2 when diagnosed, my doctor showed me a little chart on the A1C ranges. I was in the "high"range (9 and up) just on the low end of it. Not good. I think that 7 to 9 was “medium high” and 4 to 6 was the “good” range.
Anything above 9 was considered risky to stay in. Now I am in the “good” range, or as some called it on here “non-diabetic” range because you want to aim to be at the “normal” percentages between 4 and 6 because that would be normal functioning range of the body without diabetes. At least that was how I was described it.
“In fact, the existing NICE guideline calls for 6.5 per cent HbA1c, even further away from the level the evidence suggests is ideal. (NICE guidelines and the guidelines NICE helps produce for QOF are not identical. Why? Don’t ask.)”
I am guessing their NICE is their version of our AACE? I think it strange that the AACE recommends lower guidelines than the ADA. I am very, very grateful that I was diagnosed in this country and not in the UK!
Wow! Really Gerri - ADA was opposed to glucose testing at home. I can now understand why some of my American diabetic friends say the things they do about ADA. I wonder if CDA - our Canadian version - was in the same position.
Another vote for Holger’s version of the chart! Pete - you do have a point though - there has to be a starting point - if it’s never been something that has been thrust on diabetics before. I know when I lived in England, I don’t think my GP really cared about my diabetic control. He just wrote my prescription, my GLASS syringe and needle meant for horses behind. I really had no control or help past that point. I know my Aunt who was a nurse was slightly worried about my health, but that was as far as it went (this was back in the 80’s).
I am in agreement on this. We had little thread on this a bit ago - about the real accuracy of the A1C test. It could really vary dependant on the time of month/day and the way your cells die off since they all don’t die off at one time. It can be varied dependant on your numbers around that particular time - you might be missing on some nice lower sugary cells that died off right after you took your last one or vise versa for higher sugary cells. I think it is just a guide really and on exact for your whole 3 months.
Obviously if a person continuously has a high A1C than they always have lots of sugar in their blood and they are not controlling it.
Very true Alan. Sometimes, that low A1C maybe the result of having low blood sugars all the time - have had a few polite discussions about this with friends that have A1C’s in the mid 4’s. If my A1C is based on having BG levels that I am happy with (I’m fine with 6-7%) - then I am happy - but that’s me - some people like it either lower or higher. BTW, love the droid comments - thinking of Dr. Who as I type this out!!
Ok - that explains it now Annabella - I don’t recall having an A1C done while I lived in England or glucose meters (and even then - I rarely tested my urine - I know - bad, bad, bad - we did what we had to do to survive so we could work / put food on table / etc.)!
Yeah, I like how they have “the closer you are to normal, the less chances of complications.” I have copied and pasted that paragraph alot when people say they are OK with a high A1c.
You mean you don’t want to pass out from lows to get a low A1c Anna? Last year when I was at the eye doctor, he asked the usual, how is the blood sugar question. My response was “not good.” I had been going thru a period of passing out and I was trying to explain that to him. As soon as I said not good, you could just see his body tense up and I swear he even held his breath. As soon as I said what my A1c was, he relaxed and laughed - he said mine was probably lower than his. He did not seem to hear that part about passing out but only heard that A1c.
It is interesting that their "cohort" study did not include patients with really tight control. The lowest group had an A1c around 6.4. This translates to a mean glucose of 127 mg/dL and is 1.0 away from the upper limit of 5.4 that is valid for a healthy person. So the study did not include anyone in the normal range. Still this study is used to justify the adjustment of A1c targets to 7.5?
This whole conversation just reminded me of a post I read on a different board. A T2 had an A1c in the upper 5s and her new endo told her that above 6 was the new guidelines and cut back her Metforim. She said the endo was younger. Needless to say, she is looking for a new endo but has to deal with the lower Met until she can find one. It is not just doctors in the UK that think good A1cs are bad.
There are a number of worthwhile rebuttals published in Lancet as well. I haven’t evaluated the validity of all of the claims but I’ll try to summarize http://www.ncbi.nlm.nih.gov/pubmed/20110121
The data regarding risks conflicts with UKPDS, which was prospective in newly diagnosed patients rather than a retrospective study with patients with years of D under their belt before enrollment.
The data in the lower A1cs were not normalized for weight gain. This may be important. Most treatment drugs do lead to weight gain. ACCORD authors conclude themselves that increased mortality is not due to severe hypoglycemia, so why is it they died?
There have been many advances in therapy since the study began and it is unclear how much applies to state-of-the-art treatment.
Only the first and last deciles are significant, so 7.5 might be reaching even if the data supported the conclusion that tighter control increases mortality.
I think we should mention that to achive this A1c levels, there is work to be done, It doesn’t “just happen”. A person works at it coming from different angles like diet, exercise and smaller portion sizes for food. It seems that many T2’s that I know are completely in the dark about carbs (the common misconception that bread is ok but bag of chips are bad) at all or that there is even an A1c target zone. If you want people to get it in a particular zone you need to show them how to achieve it. Just a thought to tie the two together. My friends doctor said “you’re now a diabetic” and gave him sone pills and said make an appointment in a month. That was his “education” which is really sad. So it’s not just a chart for A1c’s but the whole picture. I know you asked specifically for this particular “poster design” and I wonder if you would be able to put some common results for each secion…like green: more energy, clear mind, etc. For me the “ruler” was better but it needs more than just 3 area’s of color.
I think the concept could work at a health fair or at a walk-in clinic for a person who rarelly follows up with their physcian, or be re-worded for someone who is having their A1c checked for the first time at some kind of awareness event. Most folks who are actively involved in their care (the folks who have already answered) will the designs and information as oversimplified and, from the vast majority of responses to your post, incorrect in terms of acceptable/target A1c numbers. The stoplight image could appear misleading in that most people understand Green to mean GO or “all is well”, rather than “take care” or “check with your doctor”. The ruler image is better as it leaves room for higher or lower A1c numbers. Maybe 3 ‘levels’ is simply not enough to describe the A1c. I like a ruler that has dots on it (like an evolution timeline) that reflect the A1c and it’s symptoms/effects from a non-diabetic ‘normal’ to an ‘early detection’ slightly elevated A1c that might tell a person they are at high risk of developing Type 2 . The other side of the ruler could be for type 1s and the same number could indicate ‘excellent control’, all the way up to a high numbers.
