New targets for blood glucose readings

Status
Not open for further replies.
Vicsetter

Vicsetter

Well-Known Member
Relationship to Diabetes
Type 2
Just had my GP phone with my latest blood readings, HBa1c - 5.8 goodo thought I but no!
It appears that there are new NICE QOF targets of 7.5%. Not sure how to achieve that even if I wanted to, she suggests going to bed with a reading of 10 by reducing my night time Levemir!

If you haven't seen it:
What NICE guidance says:
? Involve patient in decisions about HbA1c target, which may be above that of 6.5% set for people with type 2 diabetes in general
? Encourage patients to maintain their target unless the resulting side-effects or their efforts to achieve this impair quality of life
? Inform a person with a higher HbA1c that any reduction towards the target is advantageous
? Avoid pursuing highly intensive management to levels of less than 6.5 %

What the study says:
? The lowest mortality risk was in patients with HbA1c around 7.5%
? Mortality risk 52% higher in patients with HbA1c around 6.4%
? Mortality risk 79% higher in patients with HbA1c around 10.6%

Sources: NICE guidance CG66; Lancet 2010, online 27 January​

Is this just another way of reducing cost for the local GP practice/NHS?
 
And me, but I think it's aimed at Type 2s (not sure why). I gather the study counted the number of deaths from heart attacks/stroke but didn't analyse the cause.
I did ask my GP if I should expect to loose a foot or have a heart attack depending on my ability to meet the new target (hollow laugh was the reply).
 
Are they not just completely contradicting themselves here?

I'm so confused :confused:
 
Vicsetter said:
If you haven't seen it:
What NICE guidance says:
? Avoid pursuing highly intensive management to levels of less than 6.5 %
​
Click to expand...


Not sure if it's the same study, but I have read comment about something which was to do with increased mortality due to severe hypoglycaemia rather than the low HBa1C itself. After all non-diabetics all have really low HBa1Cs don't they?
M
 
A bit of lateral thinking is needed here. The U shaped curve is a concept fairly common in epidemiology. In another example, people who drink the least and most have highest death rates from alcohol related diseases. Those who drink the least includes those who have over drank in the past, done the damage, and now don't drink anything; those who still drink lots are still inflicting alchohol related damage on their bodies.

With type 2 diabetes, which is more common in older people, some of whom are frail elderly people (not the most common type of T2D on these boards, remember) and some of those will suffer falls, for example from low blood sugar / hypoglycaemia. If a frail elderly person falls on their hip, for example, their hip / neck of femur may break and ultimately lead to their death, whereas it would just hurt a younger person.

Plotting HbA1cs of 6.4%, 7.5%, 10.6% against mortality rates of x - 52%; x, x + 79% would show a U shaped curve, highest at the extremities, lowest in the middle (mortality = death; morbidity = ill health in epidemiology jargon)
 
I remember this study being published too, but I didn't know it had been put into practice. So as Copepod says, statistically speaking people with A1c higher or lower than 7.5% are more likely to die - but this may be because of hypo unawareness if the A1c is very low - or maybe the people with lower values tended to be older and so were more likely to die anyway! But statistics don't necessarily apply to individuals - if you have good hypo awareness, or hypos are very infrequent then talk to your GP about it and explain that you feel the low A1c is doing you more good than harm.

Well done on the good values, I wish mine was that good! I'm sure you have worked hard for it so don't let someone tell you off becasue it doesn't meet a generic guideline.
 
katie said:
It's alot easier to understand when you've got more info. Here is a bit about the study:

http://www.hal.inserm.fr/docs/00/45/72/87/PDF/Lancet_Balkau_Simon_2010.pdf
Click to expand...

Precisely what I was thinking! We need to be aware of all the ins and outs before we can judge what is right for each of us.

One thing though. "Avoid pursuing highly intensive management to levels of less than 6.5 %" doesn't mean that HbA1c's below 6.5% are necessarily bad. It's more about how you achieve them that seems to be the issue.

Andy 🙂
 
All fine and dandy but it appears to be another QOF target for GP practices so your GP will be pushing you to not be so well controlled.
 
my gp is happy for me to have had a constant HbA1c of 6.4 for over a year now ...he wants to have the test done yearly now ...is that what they mean by
'Avoid pursuing highly intensive management '
he did advise me that a different gp is their Diabetic specialist so maybe i will get an appointment with him ??
 
I had no idea how dodgy medicine is. It seems crazy to me that they would tell people to let their hba1c get higher because of this study 😱
 
ive been 7.0-8.0 hb1cs from day one of my diagnoses ,at my last visit i was given another tab to help metphormin ,even though my daily tests show im around the 7.0 BS level, this leaves me totally confused will bring it up with my doc on next visit ,
 
oh does that mean if my HBA1C is in the middle the U I will live forever :D
The NICE guidelines are just that surely, your GP should treat you as an individual and your targets should be based on YOU not a study. If you GP
disagrees politely explain you are not a statistic but an individual that needs
specific treatment not a bunch of statistics to manage your care.
 
Status
Not open for further replies.
Back
Top