Controlling HbA1c associated with lower organ damage risk in type 1 diabetes

[DCUK NewsBot]

Controlling blood glucose levels could reduce the risk of organ impairment in people with type 1 diabetes, according to a new study. Swedish researchers explored the impact of HbA1c levels upon risks of diabetic retinopathy (eye disease) and nephropathy (kidney disease), analysing more than 10,000 adults and children with type 1 diabetes for between 8-20 years. They discovered that, as expected, higher HbA1c levels were linked to increased signs of complications, but also warned of the dangers of people with type 1 diabetes keeping their HbA1c levels too low. Those with type 1 diabetes whose HbA1c levels were above 70.5 mmol/mol (8.5%) had increased risks of damage to the eyes and kidneys compared with those who had HbA1c levels of 48-52 mmol/mol (6.5-6.9%). Milder complications were observed among people whose HbA1c levels remained above 53 mmol/mol (7%). More severe complications mainly occurred in people with an HbA1c above 70 mmol/mol (8.6%). The researchers identified that maintaining a value of 52 mmol/mol (6.9%) or below reduced the risk of organs being damaged. However, maintaining a value below 48 mmol/mol showed no further risk reduction. "We were unable to see that fewer instances of organ damage occurred at these lower levels," said co-lead author Professor Marcus Lind, from Sahlgrenska Academy, University of Gothenburg, and senior consultant at the NU Hospital Group in Uddevalla, Sweden. "As for loss of consciousness and cramp, which are unusual, low blood glucose caused a 30% rise in risk. [People] with low HbA1c need to make sure they don't have excessively low glucose levels, fluctuations or efforts in managing their diabetes." In Sweden, the HbA1c target is 52 mmol/mol or below, and 47 mmol/mol or lower in children. In the UK the target recommended HbA1c level for those with type 1 diabetes is 48 mmol/mol or below. Professor Johnny Ludvigsson, from Linköping University, who also led the research, added: "Knowing more about the association between blood glucose level and risk is extremely important since the health care services, the community, patients and their parents make heavy use of resources in attaining a particular blood glucose level. "Attaining a low HbA1c value may, in some cases, require children to be woken up several times a night, plus extra glucose monitoring and strict attention to diet and physical activity day after day, which can be extremely burdensome." The findings appear in The BMJ.

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[NicoleC1971]

Interesting for me as a type 1 given the new twist on levels below 48 (still abnormally high ) bring no additional risk reduction, and I am keen to get mine down to 39.
I wondered if the research looked into how levels below 48 were achieved. It seems to imply lots of monitoring and dose adjustment but not a low carb diet. Also the chosen metric of HBA1c might show a person with very high and low blood sugars coming in with the same number as someone with a relatively flat line and lots of blood sugars 'in target range'.
For now I am going to see how low I can get both my mean average (the HBA1c) and my modal average (my most frequently occurring numbers if my o'level maths serves me right?).
And I'll check out the BMJ article further!

 

[Bluetit1802]

Speaking as a T2, I imagine many T1s achieving HbA1c levels of under 48 do this because they have a lot of hypos and low glucose events, bringing the averages down. I also imagine that for those where this is not the case, the risk of complications must reduce.

 

[Grant_Vicat]

Controlling blood glucose levels could reduce the risk of organ impairment in people with type 1 diabetes, according to a new study. Swedish researchers explored the impact of HbA1c levels upon risks of diabetic retinopathy (eye disease) and nephropathy (kidney disease), analysing more than 10,000 adults and children with type 1 diabetes for between 8-20 years. They discovered that, as expected, higher HbA1c levels were linked to increased signs of complications, but also warned of the dangers of people with type 1 diabetes keeping their HbA1c levels too low. Those with type 1 diabetes whose HbA1c levels were above 70.5 mmol/mol (8.5%) had increased risks of damage to the eyes and kidneys compared with those who had HbA1c levels of 48-52 mmol/mol (6.5-6.9%). Milder complications were observed among people whose HbA1c levels remained above 53 mmol/mol (7%). More severe complications mainly occurred in people with an HbA1c above 70 mmol/mol (8.6%). The researchers identified that maintaining a value of 52 mmol/mol (6.9%) or below reduced the risk of organs being damaged. However, maintaining a value below 48 mmol/mol showed no further risk reduction. "We were unable to see that fewer instances of organ damage occurred at these lower levels," said co-lead author Professor Marcus Lind, from Sahlgrenska Academy, University of Gothenburg, and senior consultant at the NU Hospital Group in Uddevalla, Sweden. "As for loss of consciousness and cramp, which are unusual, low blood glucose caused a 30% rise in risk. [People] with low HbA1c need to make sure they don't have excessively low glucose levels, fluctuations or efforts in managing their diabetes." In Sweden, the HbA1c target is 52 mmol/mol or below, and 47 mmol/mol or lower in children. In the UK the target recommended HbA1c level for those with type 1 diabetes is 48 mmol/mol or below. Professor Johnny Ludvigsson, from Linköping University, who also led the research, added: "Knowing more about the association between blood glucose level and risk is extremely important since the health care services, the community, patients and their parents make heavy use of resources in attaining a particular blood glucose level. "Attaining a low HbA1c value may, in some cases, require children to be woken up several times a night, plus extra glucose monitoring and strict attention to diet and physical activity day after day, which can be extremely burdensome." The findings appear in The BMJ.

Continue reading...

Interesting when considering that doctors I knew in the late 70's onwards would talk about maintaining, as near as possible,
a level of a non-diabetic to avoid complications. Nobody would have been so precise then, and I'm not aware of significant studies at the time. I do remember being told that a typical person would reach maybe 10% after an intake of carbs but would return to 5.4% from an hour later!

 

[Steve Zodiac]

Speaking as a T2, I imagine many T1s achieving HbA1c levels of under 48 do this because they have a lot of hypos and low glucose events, bringing the averages down. I also imagine that for those where this is not the case, the risk of complications must reduce.

No they don't if you try and keep your levels below 10 for 95%+ of the time you should be able to get under 48, yes there maybe the odd hypo and hyper but thats just stupid saying "because they have lots of hypo's" DUH!

Its like saying T2 can easily do this if they starve themselves.

 

[NicoleC1971]

This is from the discussion part of the paper:
Hence the current findings suggest that clinicians should be extra vigilant about ensuring people with diabetes do not spend considerable time in hypoglycaemia and that treatment is related to good quality of life at HbA1clevels <6.5% (<48 mmol/mol) or else aim at higher levels of 6.5-6.9% (48-52 mmol/mol).
I infer from this that having good 'time in range' readings trumps having a low HBA1c but plenty of hypos as it is high but also unstable blood sugars that the microvascular system does not like. This is why cgms are a game changer in terms of making this visible to patients and clinicians.
The other thing I noted was that the duration of diabetes was no greater than 20 years by the end of this prospective cohort study and from their findings, time spent at higher levels is just as much as factor as the occasional spike.

 

[Bluetit1802]

No they don't if you try and keep your levels below 10 for 95%+ of the time you should be able to get under 48, yes there maybe the odd hypo and hyper but thats just stupid saying "because they have lots of hypo's" DUH!

Its like saying T2 can easily do this if they starve themselves.

OK. I'm stupid.

 

[MeiChanski]

My hba1c started at 47, which was hypos of 1.5-2.5mmol/l everyday with a mix of stable BGs in between. But I've reduced it to 42, with a better insulin regime and libre sensor and hypoing 1-2 a week with an occasional high. I do know a few type1s on this forum that have a hba1c of 37-38 with miminal hypos and hypers, they don't over correct or overtreat their numbers. Of course, lots of hard work. All in all, it is achievable.

 

[LooperCat]

Time in Range is just as important as HbA1c - like BMI, it’s a very blunt instrument. My last one was 35, with less than 1.7% of the time under 4mmol. Low HbA1c does not necessarily indicate loads of hypos these days, we have ever improving technology to thank for that. And a lot of hard work!