How Good Is Average Diabetic Control?

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rebrascora said:
You should be able to access the old data, as the nurse did, via Libreview, but those are pretty good results if you recall them correctly.
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On LibreLink I can see LibreView is connected to two practices but can only go back to the end of October! How can I access the old data please|?
 
You need to go to Libreview which is not part of the LibreLink app (although linked to it) but a separate website.
 
Tdm said:
I would have TIR cgm data would be quite easy to collate, i mean, we have to share our data with the clinic don't we?
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No I don’t.
When I used Libre, I used it with xDrip which was not shared and as my current CGM is self funded my clinic have no interest in it.
This may be because they are happy with my HbA1C.

And I am definitely NOT a younger user.
I am sure you did not mean to be ageist but, in my experience, age has little to do with self awareness and technical ability. For example, my parents are in their 80s and very up on tech whereas an aunt in her 60s will go nowhere near the internet.
 
helli said:
No I don’t.
When I used Libre, I used it with xDrip which was not shared and as my current CGM is self funded my clinic have no interest in it.
This may be because they are happy with my HbA1C.

And I am definitely NOT a younger user.
I am sure you did not mean to be ageist but, in my experience, age has little to do with self awareness and technical ability. For example, my parents are in their 80s and very up on tech whereas an aunt in her 60s will go nowhere near the internet.
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I'm not exactly young myself, but you are 100% right to call out ageism. We don't do that enough. Perhaps i didn't expand on my thinking enough. Its more that the younger generations grew up with the technology, so, as a group, you'd expect them to be more familiar with tech.
 
I don’t know whether I am remembering correctly, but I have a feeling the UK average discussed around the table when working on the 2015 NICE update for T1 may have been as high as 75mmol/mol which was a real surprise to me.

At that stage I think only 6-7% of T1s were able to reach the new recommended level of 48mmol/mol.

I wrote this at the time in defence of the lowering of the suggested A1c:

6.5% - Are they mad?

Because no two days with type 1 diabetes are the same. Except when they are. The ups and downs of life with T1D.
www.everydayupsanddowns.co.uk www.everydayupsanddowns.co.uk
 
everydayupsanddowns said:
I don’t know whether I am remembering correctly, but I have a feeling the UK average discussed around the table when working on the 2015 NICE update for T1 may have been as high as 75mmol/mol which was a real surprise to me.

At that stage I think only 6-7% of T1s were able to reach the new recommended level of 48mmol/mol.

I wrote this at the time in defence of the lowering of the suggested A1c:

6.5% - Are they mad?

Because no two days with type 1 diabetes are the same. Except when they are. The ups and downs of life with T1D.
www.everydayupsanddowns.co.uk www.everydayupsanddowns.co.uk
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Was it only changed in 2015? (drops jaw). I was diagnosed in 2007, but misdiagnosed as Type 2, and told the target was 6.5%, or 48mmol/mol (which I think it was, for Type 2s). When I was rediagnosed as Type 1, nobody at the hospital told me the target was higher, and as my surgery nurse was really only trained for Type 2s, she didn’t know any better! I managed the 6.5% once I'd got my basal/bolus buttoned down, but I really thought I should be aiming lower, until I decided I was happy enough scraping a 6.5%
 
everydayupsanddowns said:
At that stage I think only 6-7% of T1s were able to reach the new recommended level of 48mmol/mol.
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Yes, I do wonder how useful it is to recommend 48 given that the vast majority of us just aren't going to achieve it. I wonder if they could have phrased the recommendation better (noting that that's where the evidence points but that it's very much aspirational rather than something that most people can actually get).

That's a big reason I like the Time in Range recommendations: I (and many others) really can get >70% TIR. And even though I can't get that every day, I can get it some days and that's a boost. So it's as much motivational and it feels like recommending 48mmol/mol might be negative in that respect (though supported by the evidence on how good it would be if it could be achieved).
 
It's interesting that NICE guidelines specify a target of 48 whereas the National Diabetes Audit Dashboards show those achieving less than 58.
Is that because the Audit team have not caught up or is it because it is thought that 48 is too difficult (or not achieved by enough people) so not worth reporting upon?

The audit dashboards use the same threshold for Type 1 and type 2. It is interesting to compare the two: 36.3% of people with Type 1 achieved an HBA1C of 58 or lower whereas 63.1 of people with type 2 or other types of diabetes achieved the same target in 21/22.
 
Bruce Stephens said:
Yes, I do wonder how useful it is to recommend 48 given that the vast majority of us just aren't going to achieve it. I wonder if they could have phrased the recommendation better (noting that that's where the evidence points but that it's very much aspirational rather than something that most people can actually get).

That's a big reason I like the Time in Range recommendations: I (and many others) really can get >70% TIR. And even though I can't get that every day, I can get it some days and that's a boost. So it's as much motivational and it feels like recommending 48mmol/mol might be negative in that respect (though supported by the evidence on how good it would be if it could be achieved).
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I think Time in range is really useful, because it stops the conversations with worried nurses that start 'are you sure you’re not having too many hypos?' once an HbA1c comes back as what I would call halfway decent.
 
I find it all quite interesting because I can achieve consistent low 90s %TIR (consistent over the last 3 years of Libre use) but I find it almost impossible to achieve an HbA1c below 50 without breaching the 4% in the red guidance. I am usually about 5% in the red over 90 days but can be up to 8% below target occasionally. Most are mild and in reality many probably are not actually hypo but just Libre reading a bit lower than actual BG which is of course the case for many people. It doesn't really bother me too much although I do my best to avoid them but it does concern my consultant and Libre flags it up as an issue on my AGP report pretty much every time, especially as it shows as mostly nocturnal hypos.
I have to adjust my evening Levemir dose very regularly (daily sometimes) even to achieve this supposedly unacceptable level of hypos as my overnight levels are significantly affected by exercise and even reducing my evening Levemir down to zero, I can still drop into the red sometimes.
It takes a lot of work and being very proactive with corrections between meals to achieve 48 or below even on a low carb diet and I feel that there is no way I could achieve it if I was not low carb and/or working, but being retired I can obviously give it more attention.
 
rebrascora said:
I find it all quite interesting because I can achieve consistent low 90s %TIR (consistent over the last 3 years of Libre use) but I find it almost impossible to achieve an HbA1c below 50 without breaching the 4% in the red guidance. I am usually about 5% in the red over 90 days but can be up to 8% below target occasionally. Most are mild and in reality many probably are not actually hypo but just Libre reading a bit lower than actual BG which is of course the case for many people. It doesn't really bother me too much although I do my best to avoid them but it does concern my consultant and Libre flags it up as an issue on my AGP report pretty much every time, especially as it shows as mostly nocturnal hypos.
I have to adjust my evening Levemir dose very regularly (daily sometimes) even to achieve this supposedly unacceptable level of hypos as my overnight levels are significantly affected by exercise and even reducing my evening Levemir down to zero, I can still drop into the red sometimes.
It takes a lot of work and being very proactive with corrections between meals to achieve 48 or below even on a low carb diet and I feel that there is no way I could achieve it if I was not low carb and/or working, but being retired I can obviously give it more attention.
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Looking at the Audit data, I noticed some metrics correlating HBA1C control (albeit under 58 not 48) and treatment for Type 1. The number achieving this (higher) target is much greater with a pump than injections. Surprisingly, although more achieved it on MDI than fixed mixed insulin, the difference was not very much

Screenshot 2023-11-06 at 12.03.58.png
 
@helli
Yes, I was very surprised at how little difference there was in the achievement between Basal/bolus and mixed insulin too, BUT I would expect there would be quality of life improvement on MDI and I think the MDI figure will improve significantly with CGM whereas it is unlikely to with mixed Insulin, so I think the combo of MDI and CGM should show a dramatic improvement over the next few years. I do however also think that the basic guidance given to people needs to change in line with this. Things like telling people not to stack insulin or correct between meals etc. which becomes so ingrained in some people that they can't overcome that guidance even when it is clearly necessary sometimes and often safe to do so now with rtCGM.
I personally think that better education for everyone with regard to MDI and CGM would be a big step in improving results. We all know how much we gain from sharing thoughts and ideas here on the forum and I am certain that that has enabled me to achieve the results I get and more importantly the confidence I have in managing my own diabetes..... Not that I don't get scary wobbles from time to time as I assume everyone does and the frustrating spells when it just doesn't play ball, but mostly I have the beast reasonably well trained thanks to learning from people here. .
 
rebrascora said:
I would expect there would be quality of life improvement on MDI
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Yes, I think that's the main benefit: it allows flexibility so it makes life less constrained. I'm not so surprised there's not that much between MDI and fixed insulin. The question is whether someone can reasonably live with the constraints that mixed insulin have, and if they can I guess they can get decent results.
 
Interstelly my GP surgery want to redo my bloods in January that I only had done in October including my HBA1C even though it was the hospital did one in October well the nurse that did my foot check does actually. I actually said "oh that's mean there's something wrong" and she said "we just repeat them every 3 months". Obviously I can understand them wanti to check my cholesterol
 
Tdm said:
I'm not exactly young myself, but you are 100% right to call out ageism. We don't do that enough. Perhaps i didn't expand on my thinking enough. Its more that the younger generations grew up with the technology, so, as a group, you'd expect them to be more familiar with tech.
Click to expand...
Every time I get a break from work, I have another look at the numbers in the Diabetes Audit Dashboards.
They are not always clear to see but the orange line in this graph shows the % of people in each age group that achieve the HBA1C target of 58% (the y-axis is the one on the right). It seems to suggest little variance in age apart from a slight dip in the 50s. In fact, the guys in their 70s are doing better than those in their 20s. Maybe they have more time to look after their diabetes management regardless of their familiarity with tech.

Screenshot 2023-11-06 at 14.57.59.png
 
@helli Also interesting that older people do better on mixed insulin than MDI. Could that simply be because those older people have been on MDI all their lives and are in a regimented routine with it and perhaps those that are on MDI haven't had sufficient training or struggle with the mental agility of calculating doses in later life. Also I imagine in care homes, it is easier for staff to manage their patients' levels with fixed dose mixed insulin.
 
@rebrascora I am not sure you can tell then for certain.
The bars only indicate the percentage of people on the different systems not their ability to achieve the hba1c target on that system.
Adding up the numbers, I think the graphs are showing, for example, that 20% of the people on fix mixed insulin are in the age range 70 to 79. So more people are using a pump in the age range 30 to 39 than any other.
But this does not take into consideration whether there are more people with Type 1 in that age range.
 
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