Qrisk Assessment

[kirbyhowarth]

Hi, I'm a newbie with a question, so hello all.

A little background, I was diagnosed with Diabetes in 2017 with an HBA1C of 51, so I took it upon myself to 'right the wrong'.
I then;
Lost weight
Lowered the carbs
Ditched refined sugar (Not all 😉)
Stopped drinking
Exercised a little more than I used to, usually walking.

By this time it was 2019, but was then diagnosed with AIH and was put on steroids, bang went the blood sugar.
I did the best I could to control it, but it wasn't easy. Apart from a very brief period on 2.5 mg of gliclazide I have had zero medication for diabetes.

In early 2021 by bloods in relation to AIH were normal and I also came of the steroids. At present it looks like a will be discharged from the hospital for that, phew.

My last 12 months of HBA1C (taken every three months) have not reached 40, ranged from 36 to 39, which I believe puts me in remission?

My question is, at what point if any is remission of diabetes taken into consideration when computing a QRisk assessment and how may that be reflected in the percentages?

Thanks alot for any help, feedback, advice, it is all very much appreciated.

Kirby

 

[Lily123]

Welcome to the forum @kirbyhowarth. I can’t answer your last question as I don’t know but HbA1Cs ranging from 36 to 39 are great! Pre diabetic HbA1C ranges from 42 to 47mmol/mol. A HbA1C of 48mmol/mol gets you a diagnosis of diabetes. I will leave someone with more knowledge to answer whether that puts you into remission

 

[everydayupsanddowns]

Welcome to the forum @kirbyhowarth

Well done on your diabetes management so far! Sounds like the approaches you have taken have been very effective, and your HbA1c results are impressive.

It’s a really interesting question, and I think only the people who were part of putting the QRISK tool together would really be in a position to offer any kind of answer.

I have heard some eminent clinicians suggest that early versions of QRISK ‘didn’t work’ or ‘wasn’t meant’ for people with diabetes, though my own consultant seems happy enough to use it. Of course qrisk isn’t diabetes-specific - it’s intended for anyone, with all manners of different medical backgrounds.

I suspect it’s never going to be a perfect system, and they would have mixed and matched as many studies and meta-analyses as possible to try to establish and weight factors that adversely or positively affect risk, and then attempt to quantify and balance their impact. I suppose it is inevitable that some guesswork, assumptions, and expert opinion will have been required in that balancing. And nothing will have been simple - because research shows that two people with diabetes with identical HbA1c results and diabetes duration can have very different exposure to risk (even risk derived from glycaemia) depending on how that HbA1c is derived. Lower HbA1cs resulting from lots of highs and hypos (which you are unlikely to be experiencing) don’t seem to confer the same risk reduction as those driven by fairly gently fluctuating in-range BG levels.

I suspect, as someone relatively newly diagnosed, who has been working hard to manage their diabetes (and with impressive results) QRISK is going to struggle to accurately predict your risk.

Have you tried using the tool both with and without ticking the ‘diabetes’ box? What is the difference in the results?

 

[Eddy Edson]

My question is, at what point if any is remission of diabetes taken into consideration when computing a QRisk assessment and how may that be reflected in the percentages?

I don't think there's a very well defined position on that, but I think Roy Taylor et al would say to pick "non diabetic" after some period in remission. See eg https://bjd-abcd.com/index.php/bjd/article/download/453/649/3273 and other places where you have comments like:

Macrovascular risk is sharply decreased by weight loss, as indicated by 10-year cardiovascular risk (QRISK) decreasing from 23% to 7% after 6 months steady weight following diet-induced remission of type 2 diabetes.

It's not clear exactly what that's supposed to mean, but I think hardly any middle aged+ people could score 7% on QRISK3 if the "type 2 diabetes" switch is on.

Eg: QRISK3 isn't really applicable to me because I have peripheral artery disease which automatically shoots me into the "mega high risk" category. But if I ignore that, all my QRISK3 factors are ideal - couldn't really be any better, I think, except for being 61 - and I score 6.8% if I say "None" for diabetes status versus 11.6% if I say "Type 2".

Whether Taylor et al are correct to say "none" for T2D's in remission is a different issue. FWIW, digging into this leads me to believe that there are quite possibly factors elevating risk even when in remission - if only the lingering arterial effects of previous elevated BG.

But anyway, I think the handling of this kind of thing is clearly deficient in QRISK3, and also in all the other calculators I've looked at - EU, US, Oz etc.

 

[kirbyhowarth]

I suspect, as someone relatively newly diagnosed, who has been working hard to manage their diabetes (and with impressive results) QRISK is going to struggle to accurately predict your risk.

Agreed, I also get that feeling.
I did use the tool with and without, 'with' took me into the percentages where Statins were recommended after a phone call from my GP. He was unable to explain the percentages and how they were allocated to the various aspects of the scoring and then suggested I Google it. I am requesting another GP to contact me who can better explain my QRisk with a little more transparency and hopefully accuracy.

But anyway, I think the handling of this kind of thing is clearly deficient in QRISK3, and also in all the other calculators I've looked at - EU, US, Oz etc.

Yes, I think that there is not enough taken into consideration when evaluating any changes that impact on someone's health conditions, diabetes being a prime example with the possibilities of going into remission and how far into remission based on blood results in respect of HBA1C does it warrant down grading.

One thing I find of concern is that a diagnosis of diabetes can so quickly be set in stone over a space of several days with two HBA1C results of 51 and 50 respectively, rather than waiting three months to confirm the original result. Similar I suppose to how remission is decided.

Health is a minefield of complications.

Thanks all for the feedback it is much appreciated.

 

[rebrascora]

Interesting discussion and something that has aggravated me somewhat. Apparently I have a Qrisk of 14%. My age, sex and diabetes give me that score, despite my diabetes being well managed Type 1. My Cholesterol is 4.5 but ratios are all good and it has decreased steadily over the past 3 years since I changed from a very high carb diet to a low carb high fat way of eating. I am a normal BMI and fit and healthy, other than diabetes which I don't feel adversely affects my health.

I really resent the fact that my diabetes inflates my Qrisk so much, when I work really hard to manage it as well as I can and I am now fitter, healthier and slimmer than I was pre diagnosis, when my cholesterol level was higher but didn't warrant statins. As a result I have declined them. I also don't feel that it would be ethical for me to take statins and continue to eat as much fat as I do and I am not changing my diet which seems to really suit me and my diabetes, particularly just so that I can take statins.

Maybe I am a fool. Time will tell.... perhaps!

 

[mikeyB]

Qrisk just examines your risk of a cardiovascular event. It's crazy just to concentrate on that. Everyone has between a 30 and 50% chance of developing a cancer if they live long enough. I have a doubled risk of getting pancreatic cancer because I have chronic pancreatitis, but it's still a low number - maybe 3% as opposed to around 1.5%. I won't die from that because of regular surveys, or bowel cancer higher risk because of ulcerative colitis ditto.

You'll live longer if you don't smoke, drink alcohol or drive a car.

With regard to statins, if you have a family history of parents, uncles or cousins who have died early from CV events, it might be good idea if you take statins, they are undoubtedly helpful in such cases. For the rest of us, it's like taking insurance against drowning or falling downstairs.

 

[nonethewiser]

No way round it so dont mention diabetes as Eddy suggested & the great man Prof Taylor.

Being type 1 have to enter diabetes, but it is what it is & not something to get upset about imo.

 

[kirbyhowarth]

I really resent the fact that my diabetes inflates my Qrisk so much, when I work really hard to manage it as well as I can and I am now fitter, healthier and slimmer than I was pre diagnosis

Ditto on that.

I think the worry is it's become more cost effective to prescribe medicine than to work with the patient to find a more long term healthy alternative that can regenerate the body rather than mask or dampen the underlying issues only to have them get worse (possibly covertly) in the long term.

I, like you chose to do it myself by losing the weight (just over 2 stones) and cutting carbs with controlled portions. Some exercise but not excessive, usually just walking especially after eating for a brisk 10 minutes.
Now I did stop drinking but that was more to help my liver and my autoimmune hepatitis, I never drank a lot anyway so two and half years on I really don't miss it.

I still like sweet stuff and eat it in moderation 😉