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HbA1c Result one month on.
- Thread starter sshaw99
- Start Date
pavlosn
Well-Known Member
Jack
I stated that 5,4% is a non diabetic hba1c score. Is this incorrect in your opinion?
I stated that 5,4% is a good score for a diabetic. Is this incorrect?
Did I give bad advise to the OP in your opinion, as you seem to suggest in your last post?
I posted a graph that I found personally interesting and invited you to answer if the way I interpreted that particular graph was right or wrong. You chose not to respond to my questions.
On commenting on the graph originally you chose to look at the lowest probability points in the shaded area rather than the line representing the expected outcome simply because that gave the most favorable result to the lowest hba1c is best theory.
You then chose to quote a different extract from the report which specifically excluded the risk of CVD the very risk that the report was associating with low Hba1c and then when that was challenged you now are quoting a third extract again.
I do not mind you believing anything you like and I am perfectly willing to be convinced that my own understanding may be wrong. Particularly when it involves a technical subject on which I have no expertise.
I do object to you accusing me that I have in any way offered bad advise.
Even if you are right and 4 - 4,5% is the lowest risk range for non diabetics to be in, does that automatically make it the best range for diabetics, who can not get there without some very extreme measures, if at all?
Just out of interest, if you do not mind me asking what hba1c target do you set for yourself? I am not asking what your hba1c is, that is your personal privileged data, I am asking at what score you would like to be?
Pavlos
jack412
Expert
did you forget that you said....."A very small percentage ( less than 10%) of non diabetics have hba1c below 25 or 4,5% and a recent study has indicated that non diabetics in this range actually face increased mortality rates."
it's the exact opposite from your study when you take out the people who have hepatitis C. people under 4.5% have the best chance of living
pavlosn
Well-Known Member
Jack
Once again you fail to respond to any direct question put to you and prefer to muddle the waters instead.
I said that hba1c below 4,5 per cent is rare and to the best of my memory it was 10 per cent.
I said that the graph I posted extracted from the study I linked to in my subsequent post indicated that for non diabetics an hba1c of less than 4,5% involved a reticent increased risk. As far as I can see and you have not disagreed with this, that is what the graph shows.
You eventually extracted a different graph from the report that excludes hep-c from the analysis.
Could it be that In fact a high proportion of those that had unusually low hba1c had or were prone to hep-c and that is why excluding it affected the results.
Even if we take for granted that hba1c range of 4-4,5% is the best range for non diabetics. Does the same hold true for diabetics?
As you know there is a huge difference between a diabetic and a non diabetic and what is automatically achievable for the latter would involve intensive intervention either medicinal or dietary for the latter. And the more intensive the intervention, the higher the risk associated with it. So for a diabetic there must come a point where the marginal, if any, benefits of further reduction in hba1c must be outweighed by the increased risk of the actual treatment necessary to bring this about.
The German study I linked to said that this point is, agen from memory 5,3-5,5%.
So I ask again, in what way divi give bad advice by stating that 5,4% is a good non diabetic Hba1c to aim for?
Pavlos
britincali
Well-Known Member
- Messages
- 170
- Type of diabetes
- Type 1
- Treatment type
- Insulin
Nah screw taking it to PMs I love reading a good argument 
pavlosn
Well-Known Member
@jack412
Just out of curiosity I went back to the study to see how the numbers of non diabetic participants were broken by hba1c score.
< 40% 97 (1%)
4,0-4,4%. 469 (3%)
4,5-4,9%. 2675 (19%)
5,0-5,4%. 5691 (40%)
5,5-5,9%. 4035 (29%)
6,0-6,5%. 1132 (8%)
Total. 14099 (100%)
So only 4% of non diabetics had hba1c less than 4,5%. ( my mistake I overestimated at 10%)
Only 23% of non diabetics had hba1c of less than 5%
Only 8% were in the pre diabetic range.
69% of non diabetics had an hba1c of 5-5,9%
This does present interesting data about what an average non diabetics hba1c is. The median value is in the 5-5,4% range.
Diabetics with Hba1c > 6,5 were excluded from the study.
Pavlos
Just out of curiosity I went back to the study to see how the numbers of non diabetic participants were broken by hba1c score.
< 40% 97 (1%)
4,0-4,4%. 469 (3%)
4,5-4,9%. 2675 (19%)
5,0-5,4%. 5691 (40%)
5,5-5,9%. 4035 (29%)
6,0-6,5%. 1132 (8%)
Total. 14099 (100%)
So only 4% of non diabetics had hba1c less than 4,5%. ( my mistake I overestimated at 10%)
Only 23% of non diabetics had hba1c of less than 5%
Only 8% were in the pre diabetic range.
69% of non diabetics had an hba1c of 5-5,9%
This does present interesting data about what an average non diabetics hba1c is. The median value is in the 5-5,4% range.
Diabetics with Hba1c > 6,5 were excluded from the study.
Pavlos
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pavlosn
Well-Known Member
I think the reader can already draw his own conclusions about who is the one citing things selectively and erroneously to support his own wishes.
jack412
Expert
It's just a shame it's over a cite that doesn't support his opinion and isn't a good argumentNah screw taking it to PMs I love reading a good argument
@pav
It doesnt matter if it only 1%, that 1% without hep C and under 4.5 don't die as much as the others without hep c..and over 4.5.
under 4.5 wins
the only thing you are showing is hep c is bad and you die quicker
pavlosn
Well-Known Member
It's just a shame it's over a cite that doesn't support his opinion and isn't a good argument
@pav
It doesnt matter if it only 1%, that 1% without hep C and under 4.5 don't die as much as the others without hep c..and over 4.5.
under 4.5 wins
the only thing you are showing is hep c is bad and you die quicker
Jack
In my opinion, my statement remains correct in that below a certain hba1c the risk of all cause mortality increases even for non diabetics.
That is what was shown in the first diagram I posted.
I do not think I care what will cause me to die, I am more interested in staying alive.
The fact that once you exclude hep c from the analysis the risk of low hba1c reduces is strange. If hba1c and hep-c were completely unrelated then you would expect that removing hep c risk from the equation would not affect the mortality risk of somebody with low hba1c. The fact that the risk improves suggests some kind of correlation; not necessarily a causal relationship, I am not saying one causes the other, perhaps something else causes both.
But we are in danger of missing the wood from the trees
This is a site advising diabetics not non diabetics.
Even if you are right and an hba1c of 4-4,5% is optimal for non diabetics, does that make it so for a diabetic?
Just how much better is such a low hba1c compared to 5% or 5,5% for a non diabetic. And for a diabetic is this improvement(?) In risk not actually more than eliminated by the extra risk involved in adopting the treatment/diet regime necessary to achieve such scores (assuming they are even possible).
Are you seriously suggesting that we should advise a diabetic to aim for an hbA1c score that only 4 per cent of non diabetics can match?
My opinion still is that a score in the low fives such as 5,4 is a perfectly good non diabetic score for a diabetic to target.
Pavlos
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pavlosn
Well-Known Member
What about the German study I linked above why do you ignore that.
http://www.empr.com/both-low-high-hba1c-levels-can-up-mortality-risk/article/385905/
By the way I would very much prefer it if the reality was that the lower the hba1c the lower the chances of complications and mortality. I could then just keep trying to lower my level and improve my chances.
This certainly holds true at above normal levels.
But I understand that the law of diminishing returns applies and below a certain level reducing further actually makes things wrong.
I forget the name of the famous UK study that showed that, I think it was flawed anyway because it relied on increasing medication rather than dietary control to bring about the improvements in hba1c.
Let me turn this around.
Do you have evidence that for a diabetic ( not insulin dependent to keep things simple) there is a reduction in mortality risk by reducing hba1c from 5% to 4%?
Pavlos
http://www.empr.com/both-low-high-hba1c-levels-can-up-mortality-risk/article/385905/
By the way I would very much prefer it if the reality was that the lower the hba1c the lower the chances of complications and mortality. I could then just keep trying to lower my level and improve my chances.
This certainly holds true at above normal levels.
But I understand that the law of diminishing returns applies and below a certain level reducing further actually makes things wrong.
I forget the name of the famous UK study that showed that, I think it was flawed anyway because it relied on increasing medication rather than dietary control to bring about the improvements in hba1c.
Let me turn this around.
Do you have evidence that for a diabetic ( not insulin dependent to keep things simple) there is a reduction in mortality risk by reducing hba1c from 5% to 4%?
Pavlos
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jack412
Expert
I'm done, you are now using a pay subscription intro ..to try in a desperate way to google up something that can't be examined
C
catherinecherub
Guest
@pavlosn, @jack412,
Thread derailing is not something that the forum encourages and can result in a warning being issued. Why not take your argument elsewhere, start a new thread and see who thinks they know more than the other as it becomes tiring for people to see this sort of behaviour. Let's get back to the OP's message.
Thread derailing is not something that the forum encourages and can result in a warning being issued. Why not take your argument elsewhere, start a new thread and see who thinks they know more than the other as it becomes tiring for people to see this sort of behaviour. Let's get back to the OP's message.
Fascinating reading.
My diabetic history (12 years) has remained consistently in the 68-92 range for Hba1c. Oddly enough I have reduced to 73 was my last reading. Due for another one soon, and since the last one I have increased my metformin dosage, so will be interesting to see. About a year ago, I did Michael Mosley's 5-2 diet (I understand he helped eliminate type 2 himself as he was supposedly either type 2 or on the verge of being) He practiced 2 days fasting per week (Any 24 hr period for 2 days per week, where he only ate 600 cals- any other day, he ate what he wanted) I practiced this myself for about 4-6 months, and it was the easiest dieting ever. I keep meaning to go back on it. My Hba1c went from 75 to 68 during that time, and I also lost about 8-10 kgs
My diabetic history (12 years) has remained consistently in the 68-92 range for Hba1c. Oddly enough I have reduced to 73 was my last reading. Due for another one soon, and since the last one I have increased my metformin dosage, so will be interesting to see. About a year ago, I did Michael Mosley's 5-2 diet (I understand he helped eliminate type 2 himself as he was supposedly either type 2 or on the verge of being) He practiced 2 days fasting per week (Any 24 hr period for 2 days per week, where he only ate 600 cals- any other day, he ate what he wanted) I practiced this myself for about 4-6 months, and it was the easiest dieting ever. I keep meaning to go back on it. My Hba1c went from 75 to 68 during that time, and I also lost about 8-10 kgs
ElyDave
Well-Known Member
pavlosn
Well-Known Member
Hi @ElyDave
Hazard ratio is a measure of the relative risk of mortality. So if hba1c of 5-5,4 is taken as the reference for comparison purposes then by definition this is allocated a ratio of 1.
Other hba1c bands are then given hazard values relative to the reference band, based on the results of the study. A hazard ratio of say 0,9 is better than 1,0 which in turn is better than 1,1. The lower the number the lower the risk in relative terms.
If you look at this post/thread
http://www.diabetes.co.uk/forum/index.php?threads/Can-hba1c-be-too-low?.68973/#post-706205
you will see similar but more extensive discussion on the subject - with hba1c stated in both % and mmol/mol terms.
Briefly an Hba1c of 6,5% corresponds to 47mmol and is the threshold for diabetes diagnosis.
An hba1c of 6% corresponds to 42mmol and is at the limit of what is considered normal non diabetic ( so both your counts are in this range)
5,5% = 36,6 mmol/mol
5%= 31,1 mmol/ mol
T1s ( and any insulin dependent t2s) have traditionally been thought of as better off maintaining a higher hba1c because of the extra risk of hypos.
I know these is a view that is being challenged by many t1s on this forum as they claim that through the use of low carb diets and modern technology such as continuous glucose monitors and pumps, they are able to keep their levels both low and stable avoiding hypos.
I am a non insulin dependent t2, so have no personal experience on the matter.
Take care
Pavlos
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