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6monthly HBA1c unnecessary for well controlled diabetics.

  • Thread starter Thread starter catherinecherub
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Re: 6monthly HBA1c unnecessary for well controlled diabetics

I wish I could get 6 monthly HbA1c. Its been annually for years and I don't like it done that infrequently. Maybe I will quote NICE to my doc.
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

Dear Catherine,

Thankyou for the link. I think it goes to prove that ALL so-called professionals are confused about Diabetes in every respect.

This article, which I read twice, and I do have a high IQ - is a total mish-mash and will only serve to make doctors and patients alike
despair.

Rob
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

If you click on the NHS diabetes link in the text it takes you to the full report.
Optimal prescribing of glucose lowering therapy for patients with type 2 diabetes Oct 2012
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

I think it is even worse for Type2's who are denied test strips. If your first HBA1c is acceptable then you carry on for another year and if the next one is higher, you would wonder why as you haven't changed anything diet wise hopefully. You may have had a period of high stress, a major infection or included something in your diet that you thought was acceptable but you will never know because you were unable to carry out some testing. Now you are offered meds with still no understanding of why your HBA1c is higher. It really is not acceptable IMHO.

The whole article leaves a lot to be desired Rob. :crazy: :crazy:
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

I think that as with so many things in diabetes land that a lot depends on the individual and so treatment should be on an individual basis rather than the one rule for everyone currently used.

Personally my Hba1c's have been every 3 months then stretched out to every 6 months and TBH it would not bother me if it were moved to annually as at present I appear to be pretty well controlled, in fact I rarely test more than once or twice a week now as I am pretty sure where my levels will be at any given time unless I am trying something new in my diet, but this would be no good for others.

I guess it comes down to whether government interference in the form of NICE is a good thing or not? On the one hand there are guidelines and goals in place now for doctors to use to help us but on the other hand are blanket rules and decisions a good thing? If we all had good GP's that kept up to date with current best advice then we wouldnt need guidelines would we, just perhaps the new annual assessments of Gp's competence will produce better informed GP's. We shall see...

As it stands if diabetics are to be deprived of test strips then HbA1c's should be kept to every 3 months for anyone who does not have good control.

Down to money again perhaps?
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

I am not sure what to make of this one at all...

HbA1c's aren't the greatest indicator to how well controlled an individual really is on a day to day bases, it provide a overview and in the main gives a indicator to what level of risk the patient is at for long term complications... The HbA1c is probably more suited to T2's in an overview capacity than the T1, in the T1's every hypo masks a high!

But for every diabetic it's our day to day control that really counts, after all if we've got day to day control correct, our Hb!c's will be fine...

But with both all diabetics, the only way we will know if we are getting our day to day control right, is access to test strips and the education to understand how to use them correctly and the necessary eduction to how we may change our results for the better etc... I could see the point of changing the HbA1 from 6 monthly to a yearly test!

But because this doesn't happen then isn't doing the change more the case of sweeping things under the carpet, a case of well if we don't know it's wrong we don't need to fix it!

Edit, can one of the mods remove this repeat post please!
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

IMHO a lot depends on who is managing the diabetes.

I am managing my Type 2, with the help of my surgery for tests and prescriptions. If they treated us all as individuals, they would ask us how often we wanted HbA1cs.

I get mine every 3 months at the moment; that and my meter allow me to keep the control I want. I could probably cope with 6 months or even annually at the moment, but a longer gap would play h**l with my self-discipline; I'm quite capable of cheating, even on myself!

What worries me at the moment is the fact that dispensing practices are having their funding cut; I can see that impacting on my glucose testing strips prescription.

Viv 8)
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

The research is about using statistical analysis to determine the value of the test at 6 monthly intervals and concludes that a longer interval gives more reliable results. I suppose if more regular test makes you feel more comfortable your surgery would comply but it might be of limited value.

Your own day to day monitoring would give you better clues to your progress.
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

Firstly, your reading comprehension . The very first sentence of the linked article makes it clear that it only applies to "patients with stable diabetes". Some interesting points have been raised, but they don't apply here because you missed this minor detail.

This article, which I read twice, and I do have a high IQ - is a total mish-mash and will only serve to make doctors and patients alike despair.
Click to expand...
If you have to explicitly state that you are highly intelligent,
Thankyou for the link. I think it goes to prove that ALL so-called professionals are confused about Diabetes in every respect.
Click to expand...
Well, at best it proves that some professionals are confused about one aspect of diabetes management; not sure why you think this sweeping over-generalisation is warranted.

However, do not despair - this is entirely normal. As we gather more evidence, it's to be expected that our treatments evolve and get better - the alternative (perfect solution fallacy?) is that we get everything right on the first try... which is obviously silly.
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

My surgery only offers annual HbA1c testing anyway. And no test strips for type 2's.

As Diabetes is a slowly progressing condition, maybe it is safe to only test annually until one gets near the danger zone of a 7.5 HbA1c anyway?
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

Lucy

Problem is that a even for T2's it's not always a progressive disease that slowly changes, but can change very quickly indeed. A house move, a unusual event in the family, a job change the loss of somebody close there are many things that can change control, and most diabetics will find at different times of the their lives they will need a different management regime to maintain control, so it's important that for any diabetic that any changes are picked up quickly so the individual can adapt their management to maintain control... Because the further out of control you go, the harder it can be to pull it back in.
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

Jop:

I see. Thanks. So if people cant get a HbA1c test except annually, and cant get a meter and test strips, and are on a low income, what do we do?

it seems like a catch 22 situation to me :(
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

It is and a very unfair one...

If it was implemented it wouldn't be the first time a single piece of research hasn't done the T2 any favours...

The stopping of test strips started why before NHS cut backs, is started after a small study can't remember the name off hand, but based on 2 groups of diabetics, and they monitored the difference in outcome between the group who did get meters and the one that didn't.. At the time a lot of surgeries stopped providing test strips to T2's, the the NHS savings have caused more surgeries to discourage tests strips prescriptions...
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

If it was implemented it wouldn't be the first time a single piece of research hasn't done the T2 any favours...
Click to expand...
Please explain what you mean by this. Specifically, the article says that 6 monthly HbA1c tests result in a disproportionally large number of false positives without picking up any more true positives, and I am not quite seeing how T2 would benefit from having more false positives.

With any test, you need to consider the sensitivity, specificity and prevalence of the event you are trying to detect to decide when a test is sensible or not. That's a simple statistical fact, but it is very important. In this case, the article looks at patients with stable control, and here the event you are trying to detect (HbA1c getting worse) is so rare that a 6 monthly HbA1c is not suitable for detecting change.

Your best argument to counter it is theoretical - "We can't possibly keep control if we don't test every day/have an HbA1c every month". That is an argument from theory. If you think that that's good enough then we might just as well go back to bloodletting for everything. Where is your evidence?

I understand that not everyone can be an expert in everything (e.g. statistics), but try to charitably assume that you might not know more about everything than the experts in the respective fields. You wouldn't do your own plumbing, yet you are convinced that you know more about diabetes than endocrinologists specialising in it... :crazy:
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

Hi All.
Please refrain from getting personal or attacking other members.
Using harsh words of expression.

Thanks Anna.
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

It was certainly a statistical exercise, a post hoc analysis of data from the Farmer trial on self monitoring.

These results were obtained by statistical modelling based on observational data. Although randomised trials
are often regarded as the best source of evidence, in practice monitoring and diagnostic problems require
infeasibly large trials, even by modern standards (10). We did not have a 'gold standard' with which to
consider which HbA1c tests in the DiGEM study were 'true positive' or 'false positive'; instead we have used
modelling methods to infer the proportion of such tests that would be true or false positive, based on the
variability and rate of change.
Click to expand...
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

Over generalisation and a knock about my intelligence - very constructive criticsm I don't think. So what if we missed the word STABLE the whole article is academic?

Nobody has the answers at the moment - and we are not progressing as fast as we should.

What is it AMBrennan that you possess that makes you an expert. If you are an endocrinologists tell us?
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

There must be some inertia in reducing the testing of well controlled T2
Diabetics. I had my first 3 monthly appointment with my DSN yesterday
and she deemed that as I had dropped from 9.7% down to 5.6% along
with my response of 'thats not enough of a drop' she stated that I would
now not need to see her for 6 months.

Now there is no way that this can be deemed as stable. I think however
it does highlight the actions the NHS are having to start to look doing
to cover the increasing cost of the Diabetes explosion. I can imagine that
this approach is going to be the norm and that we as sufferers are going
to be more reliant on forums such as this as support from the NHS is
going to become too diluted.
 
Re: 6monthly HBA1c unnecessary for well controlled diabetics

He said: ‘It provides new evidence that an annual HBA1c measurement is adequate for people who are stable. I am sure NICE will take notice of this report when it publishes its updated guidance on type 2 diabetes which is being worked on at present.’

He said that anyone who had a change in treatment - either up-titration of dose or new medication - would need more frequent monitoring.

Dr Colin Kenny, a GP in County Down and committee member of the Primary Care Diabetes Society said he believed annual monitoring of stable patients to be a pragmatic solution with rising numbers of patients and that it fitted with the QOF.
Click to expand...

Stable" appears to be defined as 58 - 7.5% & to many of us, 7.5% is seriously high. My complications occurred with 6.7%. With measuring 2 hours after meals, there is time for the BG to come down after the spike from eating. I get 1 hour readings in the teens if I eat carbs, or around 8 otherwise. Are such spikes the cause of problems, even though they do not show up on HbA1c?

The implication also that diabetes checks need only to be annual, & presumably because patients are considered to be "stable" that health problems have causes other than the effects of high BG. I put my problems down to getting older. My Dr considered my diabetes well-controlled, & suggested referring me for hospital tests. Intense muscle pain made it difficult to get out of bed. Once I was moving, it was bearable.

Then I took advice from contributors to this forum, & cut the carbs. EVERYTHING got better - muscle pain, tiredness, retinopathy (early stage - it wasn't treatable.)

I suspect that the problem is that Drs are over reliant on HbA1c as a measure of the patient's condition.

At an X-PERT course follow up gathering, one heart patient said his Dr was monitoring his condition by regular HbA1c, so there was no need for self testing. When I asked him what "regular" meant, he said annual.

We have a potentially serious condition that responds well to good control. If "they" think that good control is around 58/7.5, then patients will suffer. But of course, they all know that if we follow the DUK/NHS advice (particularly high carb diet) then T2D is progressive, & they can up the medication on an annual basis.

When will they ever learn - not from the predicted & accepted "progress" to a worsening condition - but from patients like us who have got good control & stabilised our condition :?:
 
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