Is the QRisk calculation for diabetics unfair?

[Bluetit1802]

Most GP's now use the Qrisk 2014 calculator for assessing risks of CV disease over the next 10 years. http://www.qrisk.org/
My Health Centre uses it.
The only options regarding diabetes are None, Type 1, or Type 2. There are no options for entering HbA1c results.
As usual, we are all lumped together as a group, no matter how good or bad our control, and considered high risk.
Whatever your risk factors, if you tick the "none box" your risk almost halves.
My GP and no doubt many others use this calculation to prescribe medication to reduce the risk, (normally statins) and let us know in no uncertain terms that we are high risk.

My question is, is this fair? Are those of us that have HbA1c levels outside the diabetic range still at high risk as long as they are kept at those levels, especially if the disease was caught early enough and hadn't already done some damage? If our weight, BP and cholesterol are normal, are we still at high risk?. No matter that I have brought my BMI down to 23 from 31, my BP is 116/67 on a recent 12 hour average, my trigs are 0.7 with good cholesterol ratios, and my last HbA1c was 46, with current averages dropping, I am still high risk on this calculator and in the opinion of my GP. I am struggling to understand this.

 

[douglas99]

It's a reactive prediction, based on diabetes as it used to be on average.
Like you, I have perfect blood pressure, HbA1c in the 'normal' range, BMI of 25, until last time good cholesterol levels, and no damage.
I exercise heavily, and eat healthily. (Mostly)
But, my cholesterol has gone up, (I know why), so yes, I probably am now more likely to be at risk of CV disease now.
So in my case, a higher score means I get more attention, based on what happened in the past.
So, overall, I'm happy to get the attention.

Then again, I also know my last blood test was the worse possible, as I deliberately went the day I came back from holiday, eating, drinking, having stopped my statins without telling them.
I figure I want to know my worst figures, and work on them, not my best.

 

[stuffedolive]

well done Bluetit, keep it up. I have the same experience with doctors who keep trying to put me on statins based on those 'risk factors' irrespective of my progress. It does, however, keep me on my toes, making sure that I continue to pay attention to my diet.

 

[sanguine]

It does, however, keep me on my toes, making sure that I continue to pay attention to my diet.

And I think that's the key. Plus my insatiable desire to give two fingers to much of the medical profession since I was diagnosed

Simplistic risk matrices like this are what they are - blunt stick averages. Like 8 out of 10 cats like Whiskas - well mine bl00dy don't!. What you can't do is apply such factors to any individual because that's not how they work. It only means that if for example it says you have a 10% chance of CVD in the next ten years, in a randomly selected population of 1000 people, 100 might have CVD in the next ten years. It cannot say who they are, all I know is that by doing what we are doing we are making as sure as we possibly can that we are always in the 90%. It's part of the box-ticking mentality that drives insurance quotes and pharma marketing.

 

[noblehead]

The risk calculator was the focus of discussion on the forum last year, as you say take diabetes out of the equation and the risks are much lower. I think the prescribing of meds should be done on an individual basis, taking into account all risk factors including family history and current health.