HbA1c 47 = Way Back. HbA1c 48 = Sorry, Too Far Gone

[Ronancastled]

This is something that's annoyed me since diagnosis. The first thing we find when we Google our condition is that diabetes is a progressive chronic condition yet prediabetis is a preventable state.

What were talking is an average blood sugar of 7.6 vs 7.8, it's not a definitive line in the sand. It runs the risk of making some newly diagnosed give up hope.

I have had some great success along my journey which I have documented here.
https://www.diabetes.co.uk/forum/threads/fbg-4-1-hba1c-33-and-passed-ogtt.175834/

I believe the narrative has to change. The clinicians are too focused on metrics and not the individual patient. The messy terminology of resolved/remission needs proper criteria agreed across all bodies and not just left to individual practices.

I've read of patients declared resolved with one HbA1c in the mid 40's whereas others having low 30's for years getting the condescending "well controlled " from their surgery nurse. Had that patient never reached 48 then they would never feel like they were a failure for life.

Back pre 1997 you wouldn't have recieved a full diagnosis unless your FBG was 140 mg/dl (7.8). The grey area is far wider than the medical community would lead you to believe. The potential for improvement and a return to normoglycemic is far more variable than a decimal point.

 

[EllieM]

Back pre 1997 you wouldn't have recieved a full diagnosis unless your FBG was 140 mg/dl (7.8). The grey area is far wider than the medical community would lead you to believe. The potential for improvement and a return to normoglycemic is far more variable than a decimal point.

Agreed, and it's not just a question of a decimal point, the boundaries appear to vary widely geographically as well. So in one country you're diabetic, in another prediabetic and in a third you're non diabetic.

 

[JohnEGreen]

It's all arbitrary and the levels were set many moons ago by committee and as at the time treatments for diabetes were severely limited they were set high in order to limit the number of people being diagnosed as they had no ability to treat the majority of those that would have been diagnosed the numbers have not been revised much since then.

I personally believe that the demarcation of pre-diabetic or diabetic does not exist in reality there is just diabetic or not diabetic of course if the official statistics reflected that there would probably be getting on for twice the number of diagnosed diabetics than there are at present which probably would be a disaster for the Health services.

Edit to add.

I am of course talking about T2 diabetes.

 

[Member496333]

The pathology is identical - hyperinsulinemia that is eventually unable to prevent hyperglycaemia. The diagnosis criteria is an arbitrary line in the sand. In fact we should be profiling insulin instead of glucose but that's probably another topic for another day.

 

[Resurgam]

It might seem arbitrary, but I realised that once I was seeing under 8 mmol/l my numbers improved all by themselves, just by sticking to the meals which gave me those under 8 readings.
It was as though a plug had been pulled, a switch thrown, so perhaps that figure of around 7.6 is not guesswork but has some real significance.

 

[JohnEGreen]

It might seem arbitrary, but I realised that once I was seeing under 8 mmol/l my numbers improved all by themselves, just by sticking to the meals which gave me those under 8 readings.
It was as though a plug had been pulled, a switch thrown, so perhaps that figure of around 7.6 is not guesswork but has some real significance.

Things did change somewhat for the better in the 1990's when classifications of diabetes were rivised again.

"The previous classification of diabetes was based on the extent to which a patient was dependent on insulin.3 Although this was a logical distinction that separated the two main forms of diabetes, it gave rise to clumsy and sometimes confusing subcategories. Both the reports of the American Diabetes Association and the WHO recommend altering the classification to define four main subtypes of diabetes. Type 1 includes immune mediated and idiopathic forms of β cell dysfunction which lead to absolute insulin deficiency. Type 2 diabetes is disease of adult onset, which may originate from insulin resistance and relative insulin deficiency or from a secretory defect. Type 3 disease covers a wide range of specific types of diabetes including the various genetic defects of β cell function, genetic defects in insulin action, and diseases of the exocrine pancreas. Type 4 disease is gestational diabetes."

This from a very dated article by modern terms 1998 I think.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113665/

Things have changed a lot since it was published I agree and I suppose that even the arbitrary can by chance or other means get it right.

I still maintain that those described as pre-diabetic should in reality concider them selves as diabetic and act accordingly. And I do believe the health system should do the same. This is of course just my opinion and any one is free to agree or disagree as they see fit.