Remission - not for me apparently!

Barrowman

Barrowman

Well-Known Member
Relationship to Diabetes
Type 2
I had my diabetes blood test recently, my A1c was down from 50 to 49.

What I would like to understand is why I've been advised to aim for an A1c of 58 which obviously means that I will never get into remission. Can anyone explain why this is as my recent db check-up at the surgery couldn't offer any information as to why...Thanks
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Barrowman said:
I had my diabetes blood test recently, my A1c was down from 50 to 49.

What I would like to understand is why I've been advised to aim for an A1c of 58 which obviously means that I will never get into remission. Can anyone explain why this is as my recent db check-up at the surgery couldn't offer any information as to why...Thanks
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Are you sure you didn't mis hear and they said 48.
 
@Barrowman - If you feel comfortable saying, it'd be help to know your age.

I do know that target levels for those living with diabetes tend to be a bit higher for folks with a few miles on the clock.
 
Barrowman said:
Hi @Leadinglights, I just checked my paperwork, and it wasn't 58; it was 53. Obviously, my memory isn't what it was.
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They are probably actually looking at the NICE guidelines which do suggest an more lenient HbA1C is acceptable for those of more mature years taking into account other risk factors and health conditions and a personalised target should be given. This came from some research that found more elderly were being over medicated in order to maintain a lower HbA1C putting them at risk of other complications.
 
@Leadinglights You would have thought somebody at the surgery could have come up with an answer like that, it does make sense when you think about it. Thanks.
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Barrowman said:
I had my diabetes blood test recently, my A1c was down from 50 to 49.

What I would like to understand is why I've been advised to aim for an A1c of 58 which obviously means that I will never get into remission. Can anyone explain why this is as my recent db check-up at the surgery couldn't offer any information as to why...Thanks
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I've started getting 53 quoted at me as a target, because of my age (and I’m a mere 68, I don’t feel old!) I think it’s because the risk of complications in 20 yrs time is balanced against the risk of hypos now.(though I’m fully intending to be around when I’m 88)
 
Barrowman said:
@Leadinglights You would have thought somebody at the surgery could have come up with an answer like that, it does make sense when you think about it. Thanks.
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Looking at where you are and your BMI then I would have thought that maintaining where you are would be acceptable, so keep doing what you are but maybe allow yourself the treat now and again.
 
Robin said:
I've started getting 53 quoted at me as a target, because of my age (and I’m a mere 68, I don’t feel old!) I think it’s because the risk of complications in 20 yrs time is balanced against the risk of hypos now.(though I’m fully intending to be around when I’m 88)
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Thanks, @Robin I think you and Leadinglights have both hit the nail on the head, I'm going to have to start eating more carbs to get it up again. Looks like there's no remission for us.
Oh, and I don't feel old either.. 😉
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Leadinglights said:
Looking at where you are and your BMI then I would have thought that maintaining where you are would be acceptable, so keep doing what you are but maybe allow yourself the treat now and again.
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I'll do that @Leadinglights and I'll start tomorrow with a jam doughnut, I haven't had one for two years and that will be my treat for this week....😉
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I'm 78 and my DN is happy with HbA1c's in the mid 50's, and so am I.

Trying to drive it down to "remission" levels without medication would be the one hell of a faff. It is something I am not going to put up with when the only benefit would be a small reduction in risk of long term complications from diabetes when something else will get me first. She is also concerned that I might finish up increasing the risk of me falling and that is not a good idea.

So the idea of "remission" is not for me and it is a term you will not find me using much. It has a value as a target for many, but not for all.
 
Barrowman said:
I'll do that @Leadinglights and I'll start tomorrow with a jam doughnut, I haven't had one for two years and that will be my treat for this week....😉
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LOL! I'm not sure the surgery's intention was to encourage you to hit the doughnuts @Barrowman

Interestingly I saw a presentation on this at a conference some years before NICE tweaked their HbA1c target guidance to be more individualised.

It mentioned case studies of people with diabetes in older age, happily pottering along with an HbA1c in the low 50s, only to have medics ramping up meds in an attempt to get them down to the hallowed 48mmol/mol. But these additional meds induced a much greater risk of hypoglycaemia... which then gave rise to a fall... and then an inpatient stay with a broken hip, from which the poor person never really recovered.

I'm really glad that there's a bit more nuance in the targets now - but I suggest just because they've put numbers on paper doesn't necessarily mean you have to target those results by any means necessary (doughnuts!). If you are currently experiencing no hypoglycaemia, and you aren't on meds that are likely to cause it I'm not sure there's much benefit in raising your HbA1c from the excellent 49mmol/mol you are achieving.

If your HbA1c is below that which the guidance recommends, you might want to review any meds you are taking - but depending on what those are, you might just want to keep going as you are? 🙂
 
Jam doughnuts are a bit much for me but at this moment I am brewing up some apple chutney with sugar and dried fruit in it along with other bits and pieces. It would horrify many, but in small quantities alongside some ham, fried farm sausages or cheese from a local dairy it will go down a treat without me worrying about my HbA1c - provided I do not have a sub 42 target.
 
It's not uncommon to see various professional organisations recommending an HbA1c 53 mmol/mol = 7.0% target for T2D's in general, regardless of age.

Eg the American College of Physicians: https://www.acpjournals.org/doi/10.7326/m17-0939

Guidance Statement 1:​

Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care.

Guidance Statement 2:​

Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.

Guidance Statement 3:​

Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%.
 
Well my target is 58, because of my age - but nobody ever told me they'd increased it from 48 until I saw yet another different Houseman, who said my HbA1c wasn't too badly adrift from target which I immediately challenged and said that I called 66 one helluva way away from 48 myself and did not like it - when it had hovered around the 53 ish for years and she looked taken aback and said in a VERY supercilious tone No, your target is 58, not 48! and then just wanted me out of the office so whizzed through whatever she hadn't covered like an express train.

I was glad to be out of there, frankly.
 
Barrowman said:
I had my diabetes blood test recently, my A1c was down from 50 to 49.

What I would like to understand is why I've been advised to aim for an A1c of 58 which obviously means that I will never get into remission. Can anyone explain why this is as my recent db check-up at the surgery couldn't offer any information as to why...Thanks

13.5.22... BMI: 24.6 ....A1C 89 ---------- 13.7.23...BMI 22.9...A1c 42 ---------23.9.24 BMI 21.6....A1c 49
27.8.22 ...BMI 19,8 .....A1C 42 ---------- 06.11.23 BMI 21.8...A1c 46
1.12.22... BMI 21.4 .... A1C 39 ---------- 12 01 24 BMI 23.2...A1c 46
3.02.23... BMI 20.9..... A1C 46 -----------02.03.24 BMI 22.6...A1c 50
5.04.23 ...BMI 21.4 .....A1C 45 ----------- 30.06.24 BMI 21.6...A1c 50
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@Barrowman. Given your history, is there any reason why you can't target A1c 39-42 again? Diet or exercise?
 
JITR said:
@Barrowman. Given your history, is there any reason why you can't target A1c 39-42 again? Diet or exercise?
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Thanks, @JITR, for your comment. A Diet won't be on the cards, as the good lady reckons I don't eat enough as it is and I'm currently happy with my BMI. As far as exercise goes, I'm out on my bike most days and cycle between 5 and 15 miles, weather permitting.

So for the future, I shall carry on as I have been doing for the past 2.5 years which is eating with caution, having the occasional treat and being satisfied at the age of 80 I'm still here to do it. Oh, I did have a jam doughnut for those who may be interested. :D
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