Hair transplant safety with diabetes hba1c test

[Snowman123]

I've recently been refused a hair transplant in a hospital because my hba1c blood test was 7.3. This was against the hospital clinic's guidelines that refuse the procedure over 6.0 for diabetics. My reading at the time of pre treatment was 5.8 taken an hour before the scheduled procedure.

The hospital is based in Istanbul, Turkey and uses a UK based partner to market it's services and guidelines. The UK partner is who i contracted the services of the Turkish hospital clinic with.

As part of the process I was required to make a full medical disclosure to them, which I did. My diabetes 2 is tablet controlled and historically is in a range of 6.8 to 7.3 and my endocrinologist has written certifications to various authorities to say my condition is under control. That said i need to try harder to lower it.

I have asked the UK based partner and the Turkish hospital for the clinical basis for refusing treatment for sub 6.0 hba1c persons without an answer - simply that health standards in Turkey are different. I find this irrelevant as their partner and customers are in the UK.

The specialist did say that there was an unacceptable risk of infection on the scalp in the healing process around the newly implanted hair follicles and donor area extraction at the back of the head, together with the increased possibility of lack of blood circulation to the hair follicles.

I rang Diabetes UK for guidance and they questioned the threshold of 6.0 by definition for diabetes and indicated that surgical guidelines of below 8.0 are acceptable.

Can anyone throw any light on this from a clinical basis perspective, and where i should go to have an independent professional opinion that i can refer to in conversation with other hair transplant clinics that may be willing to take me on?

 

[Inka]

@Snowman123 If it’s a private clinic, I suspect they’re doing it for their own protection and reputation as well as your health. I think an HbA1C of 7.3 works out at just over 53 in U.K. measurements. Are you saying they did your HbA1C in Turkey just prior to the operation or was it done in the U.K.? What was the last HbA1C result before that one?

Were you out of pocket because of the cancellation or were you insured?

The U.K. guidelines aren’t really relevant in my opinion. Their agent in the U.K. is only a convenient processor and would be following the clinic’s guidelines.

Do you test your blood sugar at home? Maybe before another appointment you could increase that in order to really push your HbA1C down.

 

[Snowman123]

Are you saying they did your HbA1C in Turkey just prior to the operation or was it done in the U.K.? What was the last HbA1C result before that one?

Yes, they did the HbA1C test a couple hours before the procedure was due on 23 Nov 22. My previous HbA1C test was done 20 Sep 22 and spiked at 7.5 due to poor eating disciplines over the 3 month period.

Were you out of pocket because of the cancellation or were you insured?

I wasn't insured, but not sure medical travel insurance could cover this anyway. Well, the UK referral company has refunded me the procedure component, but I'm out of pocket for flights, accommodation, hospital tests and consultations. Then there's loss of opportunity and issues surrounding the administrative process of the referral company since they didn't disclose their published policy guidelines to me beforehand of not performing procedures on persons over 6.0, despite having full disclosure. That's another story, which I'd rather not go into, as it drifts OT, suffice I'm going down both a legal and chargeback route to get my money back

Do you test your blood sugar at home? Maybe before another appointment you could increase that in order to really push your HbA1C down.

I don't and I guess I should.

One thing I'm picking up from the hair transplant community is that there appears to be no standardised approach between clinics. That's why in the OP I'm trying to break down the medical objectivity v subjectivity with medical guidelines for a procedure that in extreme cases will cause problems with healing, potential infections that are hard to treat and potential failure of the transplanted hair follicles due to blood circulation issues.

The refusal of the clinic, was in line with those problems I've cited, that they did not want to risk. Chances are, from what I'm hearing, is that there are a myriad of other clinics that would have done the procedure. But on what clinical basis?

 

[Inka]

You sound like you’ve done a lot of research @Snowman123 which is very sensible. I’m sorry you lost money on your flights and that you were turned down at the last minute. That must have been frustrating and stressful, in addition to the financial issue. The policy should have been made clear to you beforehand, for sure.

I think a home blood glucose meter would be a great idea. It would give you knowledge to improve your HbA1C and tighten your control before any future procedures. I can’t comment on the specific risks of a hair transplant with diabetes but in general good control is important for recovery. I know I’ve read of others on this forum who’ve been told to improve their HbA1c before surgery (no hair transplant surgeries that I remember unfortunately).

I guess you’re looking for a number - a maximum HbA1C? I don’t know and I suspect it depends on a number of other factors eg age, other medical conditions, procedure being undertaken, etc. I wouldn’t necessarily think that clinics that would have done your procedure with your HbA1C are better. I’d tend to think they were more desperate for patients.

 

[Snowman123]

As a matter of interest what is the range of an HbA1C for a person with diabetes 1 ( I'm diabetes 2 ) ?

The context of my question is that I'm observing a patient of the clinic stating on a verified review site ( Trustpilot ) that the clinic I went to, successfully performed a hair transplant on him with diabetes 1 and I'm wanting to question why the clinic would treat them differently to myself if the threshold is an HbA1c of 6.0.

 

[Lucyr]

As a matter of interest what is the range of an HbA1C for a person with diabetes 1 ( I'm diabetes 2 ) ?

The context of my question is that I'm observing a patient of the clinic stating on a verified review site ( Trustpilot ) that the clinic I went to, successfully performed a hair transplant on him with diabetes 1 and I'm wanting to question why the clinic would treat them differently to myself if the threshold is an HbA1c of 6.0.

Perhaps the T1 you read a review from does have a hba1c under 6.0?

 

[Inka]

As a matter of interest what is the range of an HbA1C for a person with diabetes 1 ( I'm diabetes 2 ) ?

The context of my question is that I'm observing a patient of the clinic stating on a verified review site ( Trustpilot ) that the clinic I went to, successfully performed a hair transplant on him with diabetes 1 and I'm wanting to question why the clinic would treat them differently to myself if the threshold is an HbA1c of 6.0.

The target we’re supposed to aim for is 6.5% (48) or below, but in some circumstances eg pregnancy if someone had an HbA1C of 48 that would be considered sub-optimal - ie technically ok but higher than wanted in the circumstances. My HbA1c during my last pregnancy was around 33 (5.2%). I’m using pregnancy as an example because that’s the only experience I’ve had of a special situation with tight targets.

I don’t know what the target is for elective surgery and I guess it would vary slightly, but would probably be close to the 6.5% (48) or below.

 

[Snowman123]

Perhaps the T1 you read a review from does have a hba1c under 6.0?

I don't know, but am curious if a T1 can be sub 6.0 , unlike T2 ?

I don’t know what the target is for elective surgery and I guess it would vary slightly, but would probably be close to the 6.5% (48) or below.

I haven't read the 44 pages of this https://www.diabetes.org.uk/profess...y-and-elective-procedures-improving-standards , but when i called Diabetes UK the advisor told me that below 8.0 was considered safe.

I guess safe and a successful hair transplant are two different things. The increased risks I cited earlier from the clinic's perspective was that of infections that are hard to medically manage ( a condition they named but i can't remember ) and poor blood circulation to the hair follicles ( caused I believe by the covering of the follicles with blood sugars ??? - please correct me as I can't remember exactly ).

With other clinics available to do the procedure for me, I really don't know who to believe when trying to assess risk from my perspective.

 

[Lucyr]

I don't know, but am curious if a T1 can be sub 6.0 , unlike T2 ?


I haven't read the 44 pages of this https://www.diabetes.org.uk/profess...y-and-elective-procedures-improving-standards , but when i called Diabetes UK the advisor told me that below 8.0 was considered safe.

I guess safe and a successful hair transplant are two different things. The increased risks I cited earlier from the clinic's perspective was that of infections that are hard to medically manage ( a condition they named but i can't remember ) and poor blood circulation to the hair follicles ( caused I believe by the covering of the follicles with blood sugars ??? - please correct me as I can't remember exactly ).

With other clinics available to do the procedure for me, I really don't know who to believe when trying to assess risk from my perspective.

Yes of course a T1 could have an a1c under 6%, that’s under 42 in new numbers and the target for many diabetics of all types, since 42+ is high blood sugar and 41 or below is control as good as the non diabetic range

 

[Robin]

I don't know, but am curious if a T1 can be sub 6.0 , unlike T2 ?

I think the reason Type 1s are told to aim for 6.5% (48) is a multi pronged compromise.
Up to this figure, the risk of long term complications doesn’t get any worse.
Getting your number down lower takes much more effort and micromanaging, and the 'experts' are concerned about diabetes burnout.
It is felt that aiming at a lower target may cause an unacceptable number of hypos, and that hypos are more dangerous than having a slightly elevated HbA1c.
But certainly below 6% is possible for a Type 1, hence @Inka 's reference to pregnancy targets.

 

[Inka]

I don't know, but am curious if a T1 can be sub 6.0 , unlike T2 ?

Yes, they can. The HbA1C isn’t quite as useful for Type 1s as if a Type 1 were having lots of hypos, an apparently good HbA1C could mask that. Many Type 1s prefer to look at Time in Range on the Libre sensor, but certainly an HbA1C below 6.0% is possible for a Type 1. I think you assumed it wasn’t and were wondering how the Type 1 you read about got a hair transplant in that case? I don’t know, of course, but they could have tightened up their control for a period beforehand in order to achieve an HbA1C below 6.0%. It’s perfectly possible. Throughout pregnancy my HbA1Cs were all below 6%, every single one, as was my last HbA1C when I wasn’t pregnant actually.

 

[rebrascora]

And of course a Type 2 can get below an HbA1c of 42 as many here on the forum prove, even without medication, either through weight loss/Newcastle/Fast 800 diet or a low carb way of eating and using a BG meter to avoid or reduce portion size of foods which spike their levels.

My thoughts are that the clinic are looking to give their procedure the maximum chance of success and to avoid infection as well as to protect themselves legally, but I agree that 6% seems a conservative level for a cut off and you should have been advised of that and I would have thought, tested here in the UK before travelling to ensure you met their target. Bearing in mind that HbA1c is a relatively cheap and fast test and there is not going to be significant change in a few days between leaving the UK and flying out to the clinic.

 

[Leadinglights]

As the HbA1C is an average over the previous three months and is unlikely to change much over a period of a couple of weeks it would have been more sensible to do the test in the UK before you had travelled.
Not only are they protecting themselves but you also as I'm sure you would be the first to complain if the procedure had failed because of infection which would be more likely if blood glucose levels were elevated.
It is not as if it was an emergency procedure which would often have to go ahead regardless of people blood glucose level.
The worry of having these sort of things done overseas is the availability of follow up treatment if something goes wrong.
I discussed having dental implants which were a fraction of the price in Hungary but I just worried if something went wrong it would cost a lot more in the long run.

 

[Snowman123]

I agree that 6% seems a conservative level for a cut off

I'm still struggling to find anything specific online that indicates an HbA1C guideline for an otherwise healthy person for hair transplants. Plenty of clinics say they will take on diabetics, but none that i have seen state the clinical basis, nor an acceptable threshold.

If HbA1c over 69mmol/mol (8.5%) refer for optimisation https://abcd.care/sites/abcd.care/files/site_uploads/CPOC_Diabetes_Surgery_Guideline_March_2021.pdf

This appears in the diabetes surgery guidelines, but again nothing specific to recovery.

I guess it comes down to 2 things: a) risk of infection from FUE transplants; b) success of the procedure with good blood supply nourishing the hair follicles.

If nobody here knows, can anyone suggest where to make enquiries - can Diabetes.org.uk be approached to provide more in depth guidance?

 

[Leadinglights]

I'm still struggling to find anything specific online that indicates an HbA1C guideline for an otherwise healthy person for hair transplants. Plenty of clinics say they will take on diabetics, but none that i have seen state the clinical basis, nor an acceptable threshold.



This appears in the diabetes surgery guidelines, but again nothing specific to recovery.

I guess it comes down to 2 things: a) risk of infection from FUE transplants; b) success of the procedure with good blood supply nourishing the hair follicles.

If nobody here knows, can anyone suggest where to make enquiries - can Diabetes.org.uk be approached to provide more in depth guidance?

I think the worry also is the healing of the areas from where the transplant follicles are taken not just where they are transplanted into and that may be compromised if blood glucose levels are too high.
I agree there seems little info about what is considered too high.
One factor could be the reason for the hair loss in the first place and if it was related to high blood glucose.

 

[helli]

If nobody here knows, can anyone suggest where to make enquiries - can Diabetes.org.uk be approached to provide more in depth guidance?

Have you called the helpline?
Their number is at the top of every page.

 

[Inka]

I'm still struggling to find anything specific online that indicates an HbA1C guideline for an otherwise healthy person for hair transplants. Plenty of clinics say they will take on diabetics, but none that i have seen state the clinical basis, nor an acceptable threshold.



This appears in the diabetes surgery guidelines, but again nothing specific to recovery.

I guess it comes down to 2 things: a) risk of infection from FUE transplants; b) success of the procedure with good blood supply nourishing the hair follicles.

If nobody here knows, can anyone suggest where to make enquiries - can Diabetes.org.uk be approached to provide more in depth guidance?

If they’re all private clinics, I guess they can set their own levels - especially if any failure will impact their reviews. If I was you, I’d pick out some clinics I liked the look of and then contact them by email and ask their cut-off HbA1C level. That way you’d not only know you’d have it in writing from them.

As the clinics are abroad, then I wouldn’t think Diabetes U.K. could get involved specifically but could only give you general guidance about HbA1C levels for surgery. It looks like you’ve already phoned Diabetes U.K. and got that general advice.

You mentioned your HbA1C was higher because of a period of not great eating. I’d focus on improving that; testing lots to spot any high levels, etc.