douglas99
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I think that's what we're saying.
There is no exact figure, all I know is the one I have now, is better than the one I had at diagnosis.
We are all different and unique, depending on complications there can be no exact figure for optimum control!
My understanding s that doctors in he UK have to follow NICE guidelines or World Health Organisation guidelines not Google anything for an answer.have a google for optimum control, it isn't 6.5 or 7.5,
agreed, but we are talking non hypo probably diet controlled healthy T2, he can be 4% there is only normal pop. risk of hypoWe are all different and unique, depending on complications there can be no exact figure for optimum control!
Jack the very diagram you have put up shows 6% as the lowest hba1c for diabetics, the very advice given by the doctors.agreed, but we are talking non hypo probably diet controlled T2, he can be 4% there is only normal pop. risk of hypo
http://guidelines.diabetes.ca/executivesummary/ch8
Depends on what google comes back with. 7.5% is one of the values stated as "Optimal Control"...have a google for optimum control, it isn't 6.5 or 7.5,
That's very interesting Jack!agreed, but we are talking non hypo probably diet controlled T2, he can be 4% there is only normal pop. risk of hypo
http://guidelines.diabetes.ca/executivesummary/ch8
you with 5.2 and me with 5.4 and all the rest of the T2 under 6 and not having any hopos here..should go and eat sugar to get it up to 6-6.5?..don't think soJack the very diagram you have put up shows 6% as the lowest hba1c for diabetics, the very advice given by the doctors.
the ones under 6 are a very unique group that are back into normal non diabetic range,.... we really don't want the death rate of someone with hepatitis CThat's very interesting Jack!
It's quite a balancing act and as really complicated as I have thought often.
I think Pavlos is looking for the golden zone!!
the ones under 6 are a very unique group that are back into normal non diabetic range,.... we really don't want the death rate of someone with hepatitis C
not only that but the endo's say that at 6.6 you should be looking for another drug to get it downThe NICE targets of 6.5% for type 2's not on insulin or other potential hypo-drugs is a MAXIMUM. It is not a minimum or an optimum, and it doesn't give a range.
I assure you I have no intention toyou with 5.2 and me with 5.4 and all the rest of the T2 under 6 and not having any hopos here..should go and eat sugar to get it up to 6-6.5?..don't think so
I assure you I have no intention to.
Still wonder the advise though.
@NoCrbs4Me I'm a bit thick when it comes to those sort of graphs. Please can you explain it to me?
This is all I could find in the actual NICE guidelineAs I said Pavlos, the NICE advice is a maximum target. It doesn't say what a minimum is. (Correct me if I'm wrong)
View attachment 9577
The graph is from a 2002 paper that had the objective of defining the relationship between HbA1c and mean plasma glucose levels in type 1 diabetics. There are 1,439 points in the graph. The bottom axis is obviously HbA1c. The vertical graph is mean plasma glucose, which was estimated from seven point capillary blood glucose profiles (premeal, postmeal and bed time). They plotted up the data and obtained a regression line. This study was done before continuous blood glucose monitors were common and before the HbA1c lab test method was standardized, but it was the only plot I found yesterday.
However, I did find an updated (2012) one today that is less scattered (http://www.medsci.org/v09p0665.htm):
View attachment 9578
"Figure 3. The A1c-Derived Average Glucose (ADAG) Study Group demonstrated that HbA1c correlates well with average glucose (AG) (R2 = 0.84), however, although 90% of HbA1c concentrations predicted the average measured glucose within ± 15%, significant deviations were observed. The regression equation is: Calculated AG (mg/dL) = 28.7 x HbA1c (%) - 46.7."
So my HbA1c of 6% could mean an average blood glucose of 7 mmol/L +/- 1 (or from 6 to 8 mmol/L). Or, I could be outside the 90% and it could be very different. You can see from the graph that HbA1cs of 6% correlated to average glucose values of from 100 to 150 mg/L (5.6 to 8.3 mmol/L).
The more I read about the HbA1c test, the less weight I put on it and the more weight I put on my home blood glucose meter, which isn't all that accurate either.
I understand that generally A1c is considered the more reliable test than home testing.
But as you have shown in the graphs and links you have provided the relationship between A1c and average glucose levels, although well established is one that can only allow you to estimate your average glucose within a certain range for a specific confidence level.
The main disadvantage of home glucose tests, even setting aside the +/-15% monitor accuracy limitations, are that they are snapshots in time, only giving you a measure of your level at certain specific points in time. Of course with frequent testing you probably end up with several hundreds of these snapshots over time, giving you a better overall picture; but still not a complete picture.
As you also state in an earlier post hba1c and average glucose levels although related are not the same thing. Hba1c is an indicator of increased risk independently to its relationship to average glucose levels. There are May well be other factors affecting hba1c beyond glucose levels.
For one two factors that may affect it or even invalidate it is if there is unusual characteristics in ones hemoglobin or if the lifespan of ones blood cells.
Perhaps using your hba1c count as a means of comparing with earlier counts you may have may be more meaningful than comparing against absolute references but the latter seems to be what the medical profession is doing with diabetes being diagnosed for instance beyond a set predefined hba1c score.
Found this disclaimer from NICE when I was at work.My understanding s that doctors in he UK have to follow NICE guidelines or World Health Organisation guidelines not Google anything for an answer.
it seems they are following the KISS principal ...which may be above that of 6.5% set for people with type 2 diabetes in generalThis is all I could find in the actual NICE guideline
http://www.nice.org.uk/guidance/cg8...tyle-managementnon-pharmacological-management
1.3.1 When setting a target glycated haemoglobin (HbA1c):
involve the person in decisions about their individual HbA1c target level, which may be above that of 6.5% set for people with type 2 diabetes in general
encourage the person to maintain their individual target unless the resulting side effects (including hypoglycaemia) or their efforts to achieve this impair their quality of life
offer therapy (lifestyle and medication) to help achieve and maintain the HbA1c target level
inform a person with a higher HbA1c that any reduction in HbA1c towards the agreed target is advantageous to future health
avoid pursuing highly intensive management to levels of less than 6.5%.
Endquote
Presumably that last paragraph is a reference to the ACCORD study results.
Whether "highly intensive management" extents to dietary management as well as medicinal is not expanded on.
I actually had to google "Kiss principle" lol!it seems they are following the KISS principal ...which may be above that of 6.5% set for people with type 2 diabetes in general
and it fully explains why there are few under 6%..you get a big pat on the back at 6.5%
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