HBa1c Question

[MeganN]

Hi guys

Jsut got my blood results back. My HBa1c was at 7.2, nurse was very happy about that as last time it was 8.1.

Should I still aim to go lower? She said the target was 7.5 and said that she though mine would continue to come down but I'm not so sure. I would be happier at about 6.5 but don't know if I'm asking for too much.

I'm still very confused about the whole thing!

 

[Northerner]

That's a good reduction Megan, and I would expect it to reduce further in time if you continue to take good care of yourself anad manage your diabetes well 🙂 6.5% is a good figure to aim for, since this is thought to be the level at which the risk of complications is similar to a person who does not have diabetes 🙂

 

[MeganN]

That's a good reduction Megan, and I would expect it to reduce further in time if you continue to take good care of yourself anad manage your diabetes well 🙂 6.5% is a good figure to aim for, since this is thought to be the level at which the risk of complications is similar to a person who does not have diabetes 🙂

Great I will keep that as my target then 🙂

 

[robofski]

Great improvement Megan, well done! Had my blood taken this morning, get the results next Wednesday! Would love to get a number like yours but don't think I will

 

[everydayupsanddowns]

I'm pretty sure 7.5% is seen as the 'old' general target these days. It was 7.5% in the UK and 6.5% by some international body when I looked it up before.

DUK's site now suggests below 48 (6.5%) with the caveat that this target should be set individually by your clinicians based on whether aiming for it results in too many hypos.

Congrats on the reduction 🙂 Onward and downward!

 

[Vicsetter]

The target level is based on statistical evidence of complications.

See here for details: http://www.nhs.uk/Conditions/Diabetes-type1/Pages/QandAonHbA1c.aspx
for hba1c targets and other blood results:http://www.warringtonandhaltonhospitals.nhs.uk/_store/documents/diabetestargetssept08.pdf


7 to 7.5% is the general target for T2s. Your individual target should be agreed with your GP.

This is quite a useful article on determining the prescribing philosophy for T2s:
http://www.derbyshiremedicinesmanag...int/Glucose control in type 2 diabetes 09.pdf

 

[DeusXM]

It's about balance. Ultimately, a non-diabetic A1c is 4.5-5.7. Therefore, to completely minimise the risk of complications, this should be the target to aim for.

Having said that....A1C improvements give diminishing returns. Below about 6.5%, the actual risk of complications becomes minimal. You also need to weigh up how much work you're prepared to put in. Some people are very happy eating a restricted diet and living a regimented lifestyle to get an A1c in the low 5s. Others aren't. You'll need to judge for yourself how much of a trade-off you're prepared to deal with.

Interesting, NHS guidelines are very lax compared to WHO ones, I think the WHO defines 'controlled' diabetes as 6.5% or less.

 

[MeganN]

I'm pretty sure 7.5% is seen as the 'old' general target these days. It was 7.5% in the UK and 6.5% by some international body when I looked it up before.

DUK's site now suggests below 48 (6.5%) with the caveat that this target should be set individually by your clinicians based on whether aiming for it results in too many hypos.

Congrats on the reduction 🙂 Onward and downward!

I thought it was now lower than 7.5 too but our diabetes nurse at the GP surgery is still working to 7.5

Ideally I would like it as low as I can get it. Especially as I will be starting a family in the near future I want to be as Healthy as I can. The diagnosis has already put a stall on the children front as I was diagnosed right before my wedding (tad stressful).

I am tempted to go back to the hospital as I think my meds need a bit of a tweak but my nurse seems reluctant to listen about it 😡

 

[DeusXM]

This is quite a useful article on determining the prescribing philosophy for T2s:

Have to say, I'm completely shocked by the poor understanding of diabetes shown in this document:

SBGM should not be routinely available in the following situation:
(a) people with type 2 diabetes who do not take insulin (adjustments of oral
hypoglycaemic medication can be done based on HbA1c results).

Do these people have no clue that DIET plays a role in treating diabetes, and that dietary choices can only be judged based on self blood glucose management and not A1c results?

Come on, A1cs are every three months. Do doctors not feel a bit silly saying "Well, Mr Jenkins, your A1c is a bit high. So whatever you were eating in May was probably bad for you. Try to eat less of whatever you ate in May."

 

[macast]

well done Megan.... you are heading in the right direction 🙂

the only way is down lol

 

[Vicsetter]

It's about balance. Ultimately, a non-diabetic A1c is 4.5-5.7. Therefore, to completely minimise the risk of complications, this should be the target to aim for.

Having said that....A1C improvements give diminishing returns. Below about 6.5%, the actual risk of complications becomes minimal. You also need to weigh up how much work you're prepared to put in. Some people are very happy eating a restricted diet and living a regimented lifestyle to get an A1c in the low 5s. Others aren't. You'll need to judge for yourself how much of a trade-off you're prepared to deal with.

Interesting, NHS guidelines are very lax compared to WHO ones, I think the WHO defines 'controlled' diabetes as 6.5% or less.

the WHO recomends the use of HBA1c as a test for determining T2 diabetes and this was adopted as a guidline by the NHS for GPs in July last year (http://www.pulsetoday.co.uk/newsart...ideline-set-to-trigger-diabetes-caseload-rise - free registration required).
Here the figure of 6.5% is used, any result above this determines a T2 diabetic.
I couldn't find any WHO guidelines for T2 target levels. and the NHS ones are not lax at all.

It would be nice if you could back up what you are quoting with references.

 

[Northerner]

I thought it was now lower than 7.5 too but our diabetes nurse at the GP surgery is still working to 7.5...

...but my nurse seems reluctant to listen about it 😡

I do often wonder how much a practice nurse's perception of what is a 'good' HbA1c is influenced by the other cases she sees. If she's seeing a lot of double figure HbA1c's (which appears to be more than likely, given the woeful prevalence of complications), then 7.5% is going to look like amazing control and she may not be able to conceive of someone going lower 🙄 Just a thought!

Also, HCPs should always listen to their patients otherwise they are not doing a good job - things should be discussed, not dismissed 😡

 

[everydayupsanddowns]

The most recent NICE guidelines for T2 that I have on file say this:

7.1.6

Cardiovascular risk can be reduced by 10?15% per 1.0 % reduction of HbA1c, the treatment effect and epidemiological analysis of UKPDS giving the same conclusions. Mean levels of close to 6.5 % were achieved in the first 5 years of the UKPDS in both the main glucose study and the
obese (?metformin?) study in the active treatment arms. The epidemiological analysis supports a linear fall in macrovascular risk down to 6.0 % or below, and this will largely reflect data from the more actively managed group.

However, expensive therapies or very intensive interventions are required to achieve glucose control in the normal range in most people with diabetes. Consequently a population target should not be any tighter than the HbA1c of 6.5 % previously chosen for those at macrovascular risk.

and moving to recommendation:

R16 - When setting a target glycated haemoglobin HbA1c:
 involve the person in decisions about their individual HbA1c target level, which may be above that of 6.5 % set for people with Type 2 diabetes in general

Which I take to mean that 6.5% should be the standard, but they worry about pushing people to meet that target (and worry even more at pushing them to beat that target) because doing so is likely to cost more/be more difficult for people.

 

[DeusXM]

Here the figure of 6.5% is used, any result above this determines a T2 diabetic.

The obvious point being that if an individual is diagnosed with diabetes, at the time of diagnosis, their diabetes is uncontrolled. It's not a conceptual leap of logic to then deduce that 'controlled' diabetes is anything better than the best 'uncontrolled' range. Even the NHS guidelines say 'good' control is 6.5% or under but this all gets clouded with 'acceptable' control guidelines. Both the International Diabetes Federation and American College of Endocrinology also mandate 6.5% or lower as 'controlled'. Simply put, the better you can get to the 'normal' range, the better. Whether these targets are easy to achieve or not is irrelevant. We still have this dreadful hangover that A1cs better than 7 mean you must be having loads of hypos - something that might have been true in the days of Lente and Actrapid but don't really bear any resemblance to the use of pumps or flat-profile basal insulins.

 

[lauraw1983]

It's about balance. Ultimately, a non-diabetic A1c is 4.5-5.7. Therefore, to completely minimise the risk of complications, this should be the target to aim for.

Having said that....A1C improvements give diminishing returns. Below about 6.5%, the actual risk of complications becomes minimal. You also need to weigh up how much work you're prepared to put in. Some people are very happy eating a restricted diet and living a regimented lifestyle to get an A1c in the low 5s. Others aren't. You'll need to judge for yourself how much of a trade-off you're prepared to deal with.

Interesting, NHS guidelines are very lax compared to WHO ones, I think the WHO defines 'controlled' diabetes as 6.5% or less.

That's interesting, thanks for posting...I'm aiming for a 6.4% then at least!!

 

[MeganN]

I think I'm going to have a lot more luck speaking to the diabetes nurse at the hospital.

I'm having an appointment with the practice nurse next Wednesday about my diet but to be honest I can't cut much more carb out of my diet without avoiding ALL foods containing any starch. I'm trying so hard and think I need my gliclazide upped a little to help and allow me to eat a bit more normally. At the moment I'm even struggling to eat any fruit which I have horrific cravings for.

If the practice nurse still tells me to cut more out then I'm going back to the hospital for a little chat with my consultant there.

 

[everydayupsanddowns]

You might find some useful recipes here:
http://diabetes-support.org.uk/diabetesforum/index.php#category_2

or on the earlier version here:
http://www.diabetes-support.org.uk/forum/Blah.pl?c-800/

Lots of low carb ideas there 🙂

 

[MeganN]

You might find some useful recipes here:
http://diabetes-support.org.uk/diabetesforum/index.php#category_2

or on the earlier version here:
http://www.diabetes-support.org.uk/forum/Blah.pl?c-800/

Lots of low carb ideas there 🙂

Thank You 🙂

 

[mcdonagh47]

Have to say, I'm completely shocked by the poor
come on, A1cs are every three months. Do doctors not feel a bit silly saying "Well, Mr Jenkins, your A1c is a bit high. So whatever you were eating in May was probably bad for you. Try to eat less of whatever you ate in May."

A1cs are heavily skewed towards the last 10 days ... Be good in the run up to one 😉

 

[trophywench]

LOL McDonagh; so A1c is not an ideal measure of how a T2 is doing then - QED Alors - Quel surprise! - Not......

I've got this orrible feeling there was some research not ever so long ago associated with aiming for what most of us would probably regard as 'sensibly lower' A1cs under 7.5% which concluded it makes people depressed. Well of course it would; if it was the same as that 'T2s should not test because they only get depressed' one - were they perchance also not educated on how they could address their BGs if they found they were too high ........ ?