Hi
@EBartlett,
From my reading and not as medical advice or opinion:
A study which might give you some semblance of an answer is looking Diabetes Control and Complications Trial of 1986 to 1993 of TIDs and ongoing study of the trial as the EDIC study, which has recently released its 30 year findings.
My take on the DCCT, and a personal one, is that the more intensive the bsl control in the first 6 1/2 years and possibly longer on onsulin, the less diabetic eye, kidney and nerve complications occuured compared to a comparison group with less well controlled diabetes, called the conventional group.
The EDIC study is showing that even if bsl control slacked off in the intensive bsl control group, the complication rates still diverged, And heart and blood vessel problems are ore frequent in the conventiional group.
Problems:
1)the measures of the degree of bsl control were the HBAIC readings. While that might sound dandy, it is known that good range HBAICs can hide fluctuations in bsls that might be deleterious.
2) some say that what you do with BSL after the first 6 1/2 years no longer matters. A convenient interpretation if the fact that complications were still worse in the conventional group compared to those in the intensive group who slackened off.
Maybe your nurse has picked up this interpretation.
There is however, also the rather inescapable fact that non-diabetics' bsls tend to remain within a range variously set at about 3.6 to say, 6 mmol/l fasting and below say, 7 mmol/l , 2 hours after food ( i have simplified it a bit) or another assertion/ statment * is at an average bsl of 4.6 mmol/l and range 3.8 to 6.4 mmol/l, do not get the microvascular complications ( eye, kidney, nerve) or the same frequency of macrovascular complications ( e.g heart disease, stroke etc) as Type 1 Diabetics do.
The logic of trying to maintain bsls as close to these ideals seems self evident. * Dr Bernsteapin's Diabetes Solution.
That ideal at its best thus might translate to HBAICs of something like 4.8 % ( 29 mmol/mol with bsl variation of say 0.6 to 1.8 mmol/l.
What might stop health professions or TIDs and others on insulin from aiming for and achieving these results?
If you live in USA, the American Diabetes Association sets guidelines for TIDs for 2018 of HBAIC of less than 7% ( 53 mmol/mol, and a fasting range of bsl of 4.4 to 7.2 mmol/l and a 2 hour after foid kevel less than 10 mmol/l.
Why such a difference from some of the non-diabetic ranges quotes above?
The mysteries of the ADA are perhaps no stranger than any group in power. The anecdotal word is that as a doctor you might get sued if you advise lower bsls than the ADAguidelines and the patient suffers bad effects from a hypo. And the other side of that is, cynically, how likely is it that thecappearance of diabetes complications can be proven to be due to nedical negligence years later. ( anecdote per Dr Bernstein, Dr Bernstein's Diabetes University video series)
And without necessarily knowing the possible underlying rationale for the ADA figures other nation's doctors may follow the ADA guidelines.
For patients a target of less than 7% ( 53 mmol/l) is easier to reach than lower and if their insulin regime makes them prone to hypos if they get lower then that makes their immediate life easier. It is abit like assuming that 51 % as an exam result is good enough!
And with this greater degree of so called freedom than achieving better results , diet and food choices become easier.
The future with possible eye, nerve and kidnsy problems is unknowable.
And you may have experienced how antsy health professionals may become if your HBAIC, gets to 6 % ( 42 mmol/mol), because they are concerned and have assumed that to achieve that level you will invariably be suffering from hypos, and possibly severe ones ( i assume that most doctors and nurses are concerned for patient's welfare rather than their own welfare)!
I do not have the studies to hand but if you look through parts of the forum called True Grit Type One, you will see a study where even at levels of HBAIC of about 6 % ( 42 mmol/mol) progression of disbetic eye complications occurred.
The possible bsl fluctuations that would still allow this type of HBAIC result seem just a mighty tad less than highs of 18 mmol/l!!
I hope the above answers your question and gives you some 'food' for thought.
BestvWishes