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Is there something like too low HbA1C?
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<blockquote data-quote="kitedoc" data-source="post: 2044502" data-attributes="member: 468714"><p>Hi [USER=452807]@lucas12[/USER] , welcome and you have raised a very interesting point.</p><p>Answering as a Type 1 diabetic, with my reading of studies, not as professional advice or opinion:</p><p>The ACCORD study mentioned by [USER=219467]@bulkbiker[/USER] , where it was reported that intensive diabetes treatment of Type 2 diabetics which achieved low for recommended HBA1C levels had more cardio-vascular disease (CVD) has been criticised because some of the blood-sugar lowering agents used in higher doses in these individuals were found to cause heart problems e,g. Sulphonlurea agents and the 'glitazones' so this has put doubt into the certainty of the findings.</p><p>Also the finding of what they call a J or U shaped curve of 'bad' CVD outcomes in the ACCORD study and also the report mentioned by [USER=374531]@Scott-C[/USER], and by that type of curve meaning individual Type 2 diabetics with high or low HBA1C results seemed to cop the worst CVD numbers - is a suspicious finding statistically from what i have read.</p><p>I do not have sufficient grounding in stats to offered an expert opinion but i have heard this type of statistical problem mentioned in others studies where a U or J shape curve occurs.</p><p>The fact that the latter study (see [USER=374531]@Scott-C[/USER] , click the link and read conclusion) the authors point out that if you divide up the CVD outcomes according to 5ths or quintiles as they call them of HBA1Cs in other quoted studies you obtain a relatively straight line where the higher the HBA1C the greater the risk if CVD, but ..... if you do the CVD outcomes vs dividing HBA1Cresults into 4s, called quartiles, you obtain the U or J shape.</p><p>Of course it is difficult to know if the studies are close enough, comparable enough to draw firm conclusions but the difference to my less than statistically well trained eye is suspicious.</p><p>I shall see if i can find someone expert to comment or reference.</p><p>As to the conclusions made and interpreted by health professionals, IN ACCORD study there was one reported death in the intensive treatment, lower HBA1C trending group from definite hypoglycaemia buto 9 deaths from presumed CVD whuch were not proven absolutely proven to be due to CVD. Were these death from unrecognised hypos or jedication side-effects?</p><p>But as other posters , such as [USER=490842]@JAT1[/USER], [USER=468055]@Mel dCP[/USER], [USER=374531]@Scott-C[/USER], [USER=453094]@purplesally[/USER] and [USER=475901]@TriciaWs[/USER] ( and i apologise if i have missed anyone) doctors can be petulant if their patient have low-to-their-mind HBA1Cs.! Hypos have been blamed for poor CVD outcomes in ACCORD study rather than taking perhaps a broader view of the study including use cardio-toxic medications, as mentioned above. And maybe if you go hypo whikst on these medications you might increase your risk of death anyway.</p><p>And some if the same posters and others like [USER=410240]@ringi[/USER] also point out that with advances like CGM, hypos can be better anticipated and avoided.</p><p>I add to this the findings if patients on low carb diets reporting HBAIC, in the 5 % range even with low incidence of hypos also (</p><p><a href="https://doi.10.1542/peds.2017-3349" target="_blank">https://doi.10.1542/peds.2017-3349</a>. Being young adults and children with TID if will be sometime before they and others achieving low HBA1Cs are going to be able to show how they fare CVD-wise.</p><p>My final point: whikst HCPs are perhaps scared of hypos as they fear they might get sued and will take time perhaps to realise that many of their patients are not at risk of hypos, particularly off medication or on minimal least harmful to CVS ( cardio-vascular system) ones and that CGm, better education, insulins insulin pumps all help - no HCPs seem to have noticed that those in ACCORD study did not benfit C-V -wise from being on statins - NO difference !! </p><p>Why are they not crowing about that !!</p></blockquote><p></p>
[QUOTE="kitedoc, post: 2044502, member: 468714"] Hi [USER=452807]@lucas12[/USER] , welcome and you have raised a very interesting point. Answering as a Type 1 diabetic, with my reading of studies, not as professional advice or opinion: The ACCORD study mentioned by [USER=219467]@bulkbiker[/USER] , where it was reported that intensive diabetes treatment of Type 2 diabetics which achieved low for recommended HBA1C levels had more cardio-vascular disease (CVD) has been criticised because some of the blood-sugar lowering agents used in higher doses in these individuals were found to cause heart problems e,g. Sulphonlurea agents and the 'glitazones' so this has put doubt into the certainty of the findings. Also the finding of what they call a J or U shaped curve of 'bad' CVD outcomes in the ACCORD study and also the report mentioned by [USER=374531]@Scott-C[/USER], and by that type of curve meaning individual Type 2 diabetics with high or low HBA1C results seemed to cop the worst CVD numbers - is a suspicious finding statistically from what i have read. I do not have sufficient grounding in stats to offered an expert opinion but i have heard this type of statistical problem mentioned in others studies where a U or J shape curve occurs. The fact that the latter study (see [USER=374531]@Scott-C[/USER] , click the link and read conclusion) the authors point out that if you divide up the CVD outcomes according to 5ths or quintiles as they call them of HBA1Cs in other quoted studies you obtain a relatively straight line where the higher the HBA1C the greater the risk if CVD, but ..... if you do the CVD outcomes vs dividing HBA1Cresults into 4s, called quartiles, you obtain the U or J shape. Of course it is difficult to know if the studies are close enough, comparable enough to draw firm conclusions but the difference to my less than statistically well trained eye is suspicious. I shall see if i can find someone expert to comment or reference. As to the conclusions made and interpreted by health professionals, IN ACCORD study there was one reported death in the intensive treatment, lower HBA1C trending group from definite hypoglycaemia buto 9 deaths from presumed CVD whuch were not proven absolutely proven to be due to CVD. Were these death from unrecognised hypos or jedication side-effects? But as other posters , such as [USER=490842]@JAT1[/USER], [USER=468055]@Mel dCP[/USER], [USER=374531]@Scott-C[/USER], [USER=453094]@purplesally[/USER] and [USER=475901]@TriciaWs[/USER] ( and i apologise if i have missed anyone) doctors can be petulant if their patient have low-to-their-mind HBA1Cs.! Hypos have been blamed for poor CVD outcomes in ACCORD study rather than taking perhaps a broader view of the study including use cardio-toxic medications, as mentioned above. And maybe if you go hypo whikst on these medications you might increase your risk of death anyway. And some if the same posters and others like [USER=410240]@ringi[/USER] also point out that with advances like CGM, hypos can be better anticipated and avoided. I add to this the findings if patients on low carb diets reporting HBAIC, in the 5 % range even with low incidence of hypos also ( [URL]https://doi.10.1542/peds.2017-3349[/URL]. Being young adults and children with TID if will be sometime before they and others achieving low HBA1Cs are going to be able to show how they fare CVD-wise. My final point: whikst HCPs are perhaps scared of hypos as they fear they might get sued and will take time perhaps to realise that many of their patients are not at risk of hypos, particularly off medication or on minimal least harmful to CVS ( cardio-vascular system) ones and that CGm, better education, insulins insulin pumps all help - no HCPs seem to have noticed that those in ACCORD study did not benfit C-V -wise from being on statins - NO difference !! Why are they not crowing about that !! [/QUOTE]
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