Search
Search titles only
By:
Search titles only
By:
Home
Forums
New posts
Search forums
What's new
New posts
New profile posts
Latest activity
Members
Current visitors
New profile posts
Search profile posts
Log in
Register
Search
Search titles only
By:
Search titles only
By:
New posts
Search forums
Menu
Install the app
Install
Reply to Thread
Guest, we'd love to know what you think about the forum! Take the
Diabetes Forum Survey 2024 »
Home
Forums
Diabetes Discussion
Diabetes Soapbox - Have Your Say
Anyone get a hard time about low HbA1C?
JavaScript is disabled. For a better experience, please enable JavaScript in your browser before proceeding.
You are using an out of date browser. It may not display this or other websites correctly.
You should upgrade or use an
alternative browser
.
Message
<blockquote data-quote="kitedoc" data-source="post: 1893984" data-attributes="member: 468714"><p>Hi [USER=384168]@Winterwatch[/USER], This is my attempt to put some information up to show the bind that some health professional might find themselves in. It is only my thoughts and not to be taken as professional or medical opinion. It is not intended as an apologist statement regarding HCPs but information which might help us understand why sometimes HCPs are reluctant to 'move with the times', although that does not in my book translate to excusing not keeping up with new advances.</p><p>I have seen some of the research on HBA1Cs and the observation that harm/worse outcomes over time occur at high and low HBA1Cs. E.g.bmjopen.bmj.com - BMJ Open: Glycated haemoglobin A1C as risk factor of cardiovascular and all cause mortality in diabetic and non-diabetic populations:a systematic review and meta-analysis , Cavero-Redondo et al Vol7 , Issue 7, 2017 in which all causes of death outcomes were worse for HBA1C >8% (64)mmol/mol in diabetics , > 6% (42 mmol/mol) in non-diabetics with the highest all cause rate being in diabetics with HBA1C > 9 % (75mmol/mol). But <em><u>all-causes mortality was also high in diabetics with HBA1C < 6 % (42 mmol/mol) and non-diabetics < 5% (31 mmol/mol)</u></em>. This is in<em> adults where the majority of diabetics have type 2 diabetes and thus the actual length of time they have been diabetic before diagnosis will vary. Also the studies used ranged from publication in 1979 to 2013.</em></p><p>A study referred to as the <em>Diabetes Control and Complications Trial (1982 to 1993)</em>, showed that intensive intensive insulin therapy in type 1 diabetics of 6.5 years compared to conventional therapy for > 99% of a study population of 1441 people aged 13 to 39 and average HBA1C of 7% (53 mmol/mol) vs 9% (75 mmol/mol) resulted in a 35 to 76% reduction in kidney, nerve and eye complications.</p><p>A follow up study, 1994 to 2011 reported in Diabetes Care 2014 Jan (37) 1- Nathan,D and DCCT group - The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and ComplicationsStudy at 30 years: Overview reports that <em>even though the HBA1Cs of both groups trend towards being similar similar, the intensive treatment group continued to have a lower incidence of microvascular (kidney, eye, nerve) complications.</em> Also <em>for fatal and non-fatal heart attacks and strokes there had been a 58% reduction in the intensive therapy vs conventional therapy groups at a average of 18 years since the beginning in 1982.</em> This continuation of benefit despite easing off on strict control was named 'metabolic memory'.</p><p>Also hypos were more common in the intensive control group but evaluation did not find any brain injury problems in this group.</p><p>A report by the Australian Diabetes Society in 1995 (Diabetes Control and Complications Trial: Implications for Children and Adolescents) noted the inclusion of teenagers in the DCCT study and made the comment that brain development after birth was maximal around age 3 to 7 and thus hypoglycaemia may cause more damage to the brain then than at age 13 and above .</p><p>Why talk about this?</p><p>You have the first study saying keep HBA1Cs between 6 % (42 mmol/mol) and 8%(64 mmol/mol) otherwise death is more common. Another showing that intensive control in T1Ds for at least for the first 6 1/2 years (and my doctor quotes 10 years) is crucial to achieving reduced chances of developing micro-vascular complications even though continued tight control did not necessarily occur beyond the 6 1/2 or so years.</p><p>Now how many of us have seen the worst effects of hypos? Some HCPs have and I am told they are not pretty (anymore than diabetic ketoacidosis is). I recall waiting in clinic one day and seeing a teenager I had spoken with often in the past being wheeled in for her appointment, unable to speak now coherently, unable to keep attention on anything and having great difficulty walking or holding a cup. Apparently she had taken a deliberate overdose of insulin. Of course the worst cases are likely to stick in one's memory and not the fact that most people deal with their hypos and never need hospital or ambulance assistance.</p><p>Yes, whilst the above studies may have involved some use of insulin pumps and early CGM there is no distinction recorded (that I could find) into how those using such technology fared hypo-wise compared to the MDI and conventional insulin therapy groups.</p><p>One positive effect of the DCCT and subsequent studies has been initiatives like the Australia Government providing subsidies for cost of CGM consumables to all T1Ds under 21 years of age. (the rest of us have to pay usual price, even pregnant diabetics on pumps)!!</p><p>So please keep in mind that not all of us are on/can afford CGM or have been 'awarded' insulin pumps. Our HCPs are sometimes very conservative and may need assurances that we can be relied upon, and have the relevant safeguards to prevent problems with our attempts to improve our HBA1C results. The reason for excessive deaths below HBA1C of 42 mmol/l in diabetics is still not explained.</p></blockquote><p></p>
[QUOTE="kitedoc, post: 1893984, member: 468714"] Hi [USER=384168]@Winterwatch[/USER], This is my attempt to put some information up to show the bind that some health professional might find themselves in. It is only my thoughts and not to be taken as professional or medical opinion. It is not intended as an apologist statement regarding HCPs but information which might help us understand why sometimes HCPs are reluctant to 'move with the times', although that does not in my book translate to excusing not keeping up with new advances. I have seen some of the research on HBA1Cs and the observation that harm/worse outcomes over time occur at high and low HBA1Cs. E.g.bmjopen.bmj.com - BMJ Open: Glycated haemoglobin A1C as risk factor of cardiovascular and all cause mortality in diabetic and non-diabetic populations:a systematic review and meta-analysis , Cavero-Redondo et al Vol7 , Issue 7, 2017 in which all causes of death outcomes were worse for HBA1C >8% (64)mmol/mol in diabetics , > 6% (42 mmol/mol) in non-diabetics with the highest all cause rate being in diabetics with HBA1C > 9 % (75mmol/mol). But [I][U]all-causes mortality was also high in diabetics with HBA1C < 6 % (42 mmol/mol) and non-diabetics < 5% (31 mmol/mol)[/U][/I]. This is in[I] adults where the majority of diabetics have type 2 diabetes and thus the actual length of time they have been diabetic before diagnosis will vary. Also the studies used ranged from publication in 1979 to 2013.[/I] A study referred to as the [I]Diabetes Control and Complications Trial (1982 to 1993)[/I], showed that intensive intensive insulin therapy in type 1 diabetics of 6.5 years compared to conventional therapy for > 99% of a study population of 1441 people aged 13 to 39 and average HBA1C of 7% (53 mmol/mol) vs 9% (75 mmol/mol) resulted in a 35 to 76% reduction in kidney, nerve and eye complications. A follow up study, 1994 to 2011 reported in Diabetes Care 2014 Jan (37) 1- Nathan,D and DCCT group - The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and ComplicationsStudy at 30 years: Overview reports that [I]even though the HBA1Cs of both groups trend towards being similar similar, the intensive treatment group continued to have a lower incidence of microvascular (kidney, eye, nerve) complications.[/I] Also [I]for fatal and non-fatal heart attacks and strokes there had been a 58% reduction in the intensive therapy vs conventional therapy groups at a average of 18 years since the beginning in 1982.[/I] This continuation of benefit despite easing off on strict control was named 'metabolic memory'. Also hypos were more common in the intensive control group but evaluation did not find any brain injury problems in this group. A report by the Australian Diabetes Society in 1995 (Diabetes Control and Complications Trial: Implications for Children and Adolescents) noted the inclusion of teenagers in the DCCT study and made the comment that brain development after birth was maximal around age 3 to 7 and thus hypoglycaemia may cause more damage to the brain then than at age 13 and above . Why talk about this? You have the first study saying keep HBA1Cs between 6 % (42 mmol/mol) and 8%(64 mmol/mol) otherwise death is more common. Another showing that intensive control in T1Ds for at least for the first 6 1/2 years (and my doctor quotes 10 years) is crucial to achieving reduced chances of developing micro-vascular complications even though continued tight control did not necessarily occur beyond the 6 1/2 or so years. Now how many of us have seen the worst effects of hypos? Some HCPs have and I am told they are not pretty (anymore than diabetic ketoacidosis is). I recall waiting in clinic one day and seeing a teenager I had spoken with often in the past being wheeled in for her appointment, unable to speak now coherently, unable to keep attention on anything and having great difficulty walking or holding a cup. Apparently she had taken a deliberate overdose of insulin. Of course the worst cases are likely to stick in one's memory and not the fact that most people deal with their hypos and never need hospital or ambulance assistance. Yes, whilst the above studies may have involved some use of insulin pumps and early CGM there is no distinction recorded (that I could find) into how those using such technology fared hypo-wise compared to the MDI and conventional insulin therapy groups. One positive effect of the DCCT and subsequent studies has been initiatives like the Australia Government providing subsidies for cost of CGM consumables to all T1Ds under 21 years of age. (the rest of us have to pay usual price, even pregnant diabetics on pumps)!! So please keep in mind that not all of us are on/can afford CGM or have been 'awarded' insulin pumps. Our HCPs are sometimes very conservative and may need assurances that we can be relied upon, and have the relevant safeguards to prevent problems with our attempts to improve our HBA1C results. The reason for excessive deaths below HBA1C of 42 mmol/l in diabetics is still not explained. [/QUOTE]
Verification
Post Reply
Home
Forums
Diabetes Discussion
Diabetes Soapbox - Have Your Say
Anyone get a hard time about low HbA1C?
Top
Bottom
Find support, ask questions and share your experiences. Ad free.
Join the community »
This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies.
Accept
Learn More.…