consultant's comments on A1c levels....

[Dory]

So, I had my routine appointment with my endo consultant on Wednesday. My A1c 6 months ago was 7.1. It was again 7.1 this week. Ok, but I wanted to get it down - after all, HCPs now want Ds to get 6.5 or below, right? Well, apparently not.....

My consultant started off by saying 7.1 was great. me, never happy with myself said 'hmm, it's ok, but I want to get it below 7, as that's what all HCPs are drilling into patients now.' He then went on to explain that, whilst a few years ago, the school of thought across HCPs was that below 6.5 was preferable, recent studies had shown that although there was a significant imrpovement in overall health when Ds reduce their A1c from 8% to 7%, there was no significant improvement in overall health when reducing from 7% to 6%. In fact, the studies scarily showed that the groups who reduced from 7% to 6% also showed an increase in mortality rates (suggested as due to an increase in hypos and resulting complications).

He finished by saying 'you have great control, so don't worry'. I thought I'd died and gone to heaven; I've never, ever heard that from a HCP in my 24 years of battling with this. 🙂

Top that off with finally managing to get off the unnecessary BP meds I've been on for the last 15 years, and correcting my thyroid meds so they actually work properly, I'm pretty happy with the appointment 🙂

 

[Northerner]

Sounds great Dory! 🙂 I would still question the recommendation that dropping below 7 would be worse than staying at it, depending of course on how susceptible to hypos you are. If you can achieve lower with few hypos then in my mind that's preferable, although it may not be what the statistics are based on (i.e. maybe a lot fo the people studied that had a low HbA1c also had a lot of hypos, which doesn't make it true of everyone). I think the findings have been for some time that you are better to be stable at a higher (but still good) level than achieving an HbA1c due to widely fluctuating levels.

Great news about the thyroid and BP meds! 🙂

 

[Dory]

cheers Northy🙂

 

[Redkite]

Sounds like a very positive clinic experience. I too have seen graphs and statistics showing the correlation between Hba1c and higher incidence of complications, and there does seem to be evidence that reducing from 9 to 8 or from 8 to 7 has a strong beneficial effect, but reducing from 7 to 6 is more marginal. That doesn't mean it's not still worth striving for though 🙂. The other important factor is standard deviation, ie. making sure your levels don't fluctuate too much around their average. So an Hba1c in the 7's where most of your BGs are 4-10 is much better for your long term health than an a1c in the 6's with BGs swinging from 2-20!

 

[Cleo]

Great news dory - your consultant sounds very positive and encouraging 🙂

 

[SimplesL]

This was really interesting as at my appt on Wednesday with DN. My average was 6.7% same as before so well done, carry on the good work. But I said I hoped to get back to 6% as it was prior to the 6.7%. She understood but whilst they still like you as near to 6.5 as you can they don't think you gain anything from being near to 6 or at 1 stage I was 5.8%.

She said between 6.5 & 7 is just right.

I still think to get into the non-diabetic range as long as you don't suffer hypos should reduce future complications to those of a non-diabetic but this may be wishful thinking on my part after losing my dad (also T2) to kidney failure last month.

 

[Caroline]

that is good news.

 

[everydayupsanddowns]

Congrats on the great A1c Dory 🙂 Glad you had such a positive appointment.

I'm with Northie and Redkite on the A1c comments though. They strike me as a massive over-simplification.

A fair few years ago I had an A1c in the mid-low 7's but with lots (and I do mean lots!) of low level dips under 4, plus several occasions a year when Mrs EDUAD would have to feed me sugary things in the morning to bring me round. If the current DVLA guidelines had been in place there's no way I would have been allowed a licence and tbh I was voluntarily hardly ever driving at the time.

Fast forward 5 or 10 years and having found forums like this one I'd dramatically improved my knowledge, reduced my 'low level' dips by more than half and stopped having any of those overnight hypos. This was while still on MDI and my A1c stayed pretty static in the low 7s, eventually falling to 6.4 just before I switched to the pump.

So for me I had a lower A1c with far far fewer hypos, at a higher A1c of 7.2-7.8% and was all over the shop and well on the way to losing hypo awareness altogether.