Latest Diabetes.co.uk Newsletter

[Sid Bonkers]

In todays newsletter is the following lead story:

Lower A1c, control diabetes + cannabis

The latest National Diabetes Audit shows that in England and Wales, the number of people achieving the target HbA1c set by NICE is achieved by only 1 in 12 people with type 1 diabetes and 1 in 4 people with type 2 diabetes.

My Highlighting

Now I am not sure where that information came from but in the latest National Diabetes Audit I just downloaded it clearly says that 67% of T2's achieved the NICE recommendation for HbA1c.

Table 16 Treatment target achievement rate for patients in England with Type 2 diabetes of all ages by treatment target type

HbA1c ≤7.5% (58 mmol/mol) 67.4%

There were similar figures for Wales as well. Seems strange to see such a large discrepancy. And there was no link - that I could find - to the National Diabetes Audit, I had to google it as I knew the quoted figures were incorrect.

Also I can see no connection between the cannabis story and the National Diabetes Audit. Can anyone throw any light onto this strange newsletter?

Or am I going mad :crazy:

 

[benedict]

Hi Sid

6.5% is target HbA1c for most adults with diabetes.

Diabetes UK provide the same target
http://www.diabetes.org.uk/Guide-to.../Glycated_haemoglobin_HbA1c_and_fructosamine/

Cannabis is a separate topic of the newsletter -see the most shared news items for this story or jump here
http://www.diabetes.co.uk/news/2012...nst-obesity-and-type-2-diabetes-97296101.html

Benedict

 

[Sid Bonkers]

OK thanks for that explanation Benedict, although it does state quite clearly in the story "target HbA1c set by NICE" not "recommended by Diabetes UK" so I'm sure you can see why I was confused, especially as it seemed to mix up the headline about cannabis/obesity with the story below it about the National Diabetes Audit, that was not mentioned anywhere else that I could see.

For the record I would agree that under 6.5% is a better HbA1c target :thumbup:

 

[lucylocket61]

http://www.google.co.uk/url?sa=t&rc...-9y3Bw&usg=AFQjCNH_ies6kgiPO_pu6QnHARlmM96mXw

this is the updated NHS PDF with the NICE guideline of 6.5 It is on page 3

 

[catza]

Thanks for the link Lucy. :thumbup:

 

[the_anticarb]

I can't believe that >70% of T1s can't get their Hba1c under 7.5. And this is in the DAFNE era, what the hell must it have been like 20 or so years ago?
T2s seem to fare a little better - and probably a fair number of these still have some pancreatic function so it's not quite so hard for them, but we're still being massively failed by the system.

 

[Patch]

I wanna treat my diabetes with cannabis!!!

Jah!

 

[Sid Bonkers]

http://www.google.co.uk/url?sa=t&rc...-9y3Bw&usg=AFQjCNH_ies6kgiPO_pu6QnHARlmM96mXw

this is the updated NHS PDF with the NICE guideline of 6.5 It is on page 3

Well I cant actually find any new guidelines on page 3 or anywhere else speed reading that document but it does definitely talk about a general level of 6.5%. I wasnt aware there had been any changes to NICE recommendations, not seen any threads here about it and I would have expected to have seen something being as how hotly disputed the NICE recs were.

There certainly havent been any changes on the information given on this forum (Information to Newly Diagnosed) which still states :

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

*Before meals: 4 to 7 mmol/l
*2 hours after meals: under 8.5 mmol/l

Why have I been assuming that NICE recommended an HbA1c under 7.5% I cant find any mention of that anywhere?

I am even more confused now :crazy:

 

[lucylocket61]

Page 3, point 2

Discuss individual HbA1c target level, which may be above the general target of 6.5%.

therefore, the general target is 6.5%

also, on the flow chart, aims are lower than 6.5, when it gets above that, the flow chart continues, adding more and more interventions to try to achieve 6.5 or less.

 

[Sid Bonkers]

Page 3, point 2

Yes I said Id read that but thats not the NICE guidelines its just a sentence about a general target, later on it also talks about 7.5 and above, but it doesnt mention guidelines.

Everyone on the forum has always discussed NICE guidelines but other than the bit on the Info handed out to newbies I can find no mention of NICE guidelines at all, nothing, ziltch, nada.

I cant even remember where I have got this 7.5% into my head

.

 

[Pneu]

I think I am right in saying that the NICE guidelines recommend individually tailored targets depending on the patient in question. I am reasonably confident that the general target is currently or was 7%.. however there is a current recommendation (I am not sure if this has now been implemented) that reduces this to 6.5%.

The 6.5% recommendation in general is for those with type II diabetes and those type I's that have a history of 'good' control. That target of 6.5% can be increased up to 7.5% in cases where it may be appropriate to offset the risks of hypoglycaemic episodes.

 

[lucylocket61]

The blood sugar targets listed in Daisy1's post to new members relate to our daily ranges. I think HbA1c is different. It is lower. So a HbA1c of 6.5 is not the same as a daily test of 6.5

link here: http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

 

[BaliRob]

Dear Sid,

I agree with you 100% with your comments re HBa1C figures. I read and re-read the article and came to the same conclusion. Furthermore, the article did not continue in respect of Type 2 readers.

Rob

 

[Sid Bonkers]

Thank you Pnew and Lucy, that makes sense to me, I just couldnt work out that so many people over the last 3+ years have referred to a NICE recommendation for HbA1c as being under 7.5% and more recently under 7% and I assume from the 2012 info Lucy kindly posted that it has now been further reduced down to 6.5%, no problem with that.

But I I am still surprised that I can find no definitive "NICE recommend keeping your A1c under x%" anywhere on the web. Perhaps it was just in a leaflet or two that was given to newly diagnosed diabetics? Still seems odd to me, as I would have thought the drop in recommended Ac1 quite important news.

Lucy,I am aware of the differences between A1c and finger prick test results and appreciate that the "Daisy Info" is for day to day testing targets but thats not what I was finding confusing as I think most of us would agree with those figures with the given proviso that "However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.".

 

[Scardoc]

I can't believe that >70% of T1s can't get their Hba1c under 7.5. And this is in the DAFNE era, what the hell must it have been like 20 or so years ago?
T2s seem to fare a little better - and probably a fair number of these still have some pancreatic function so it's not quite so hard for them, but we're still being massively failed by the system.

Are we being "massively failed by the system"? Can the "system" really be blamed for >70% of T1's not being able to get their HbA1c under 7.5%? I personally don't believe so. I think a large proportion of T1's fail themselves. The problem is that it is very difficult to publish figures that show how many T1's don't look after themselves for whatever reason.

There are failings within the system and Barbara Young will tell us what they are on a regular basis and the media will then repeat this over a period of time. I still want to see the stats for how many T1's don't show for appointments, don't regularly check their BG levels, don't change their diets, don't stop drinking and who generally just don't care until it's too late. When it's too late and they have lost a foot or even died then they become an "avoidable" statistic that the NHS are blamed for.

 

[borofergie]

I can't believe that >70% of T1s can't get their Hba1c under 7.5. And this is in the DAFNE era, what the hell must it have been like 20 or so years ago?
T2s seem to fare a little better - and probably a fair number of these still have some pancreatic function so it's not quite so hard for them, but we're still being massively failed by the system.

Are we being "massively failed by the system"? Can the "system" really be blamed for >70% of T1's not being able to get their HbA1c under 7.5%? I personally don't believe so. I think a large proportion of T1's fail themselves. The problem is that it is very difficult to publish figures that show how many T1's don't look after themselves for whatever reason.

There are failings within the system and Barbara Young will tell us what they are on a regular basis and the media will then repeat this over a period of time. I still want to see the stats for how many T1's don't show for appointments, don't regularly check their BG levels, don't change their diets, don't stop drinking and who generally just don't care until it's too late. When it's too late and they have lost a foot or even died then they become an "avoidable" statistic that the NHS are blamed for.

To answer that you'd have to compare the UK figures with those of other western countries. Assuming that British diabetics (on average) care as much about their health as diabetics from other countries, the only major difference would be in the quality of medical care.

I don't know about T1 diabetics, most of what I read suggests that y'all get really good care, but I'm certain that the system is failing T2 diabetics.

 

[borofergie]

To answer that you'd have to compare the UK figures with those of other western countries. Assuming that British diabetics (on average) care as much about their health as diabetics from other countries, the only major difference would be in the quality of medical care.

Here we go, this is quite old, but relevant.

In the US in 2003 % of diabetics with A1C < 7% (from NHANES)

Diet only: 89.7%
Oral meds only: 55.3%
Insulin only: 33.2%
Oral plus Insulin: 36.3%

Is Glycemic Control Improving in U.S. Adults? - Diabetes Care
http://care.diabetesjournals.org/conten ... 1.full.pdf

2003 was a long time ago, and the US healthcare system certainly isn't the most inclusive in the world, but the numbers look comparable to the NICE ones.

 

[the_anticarb]

So it's a combination of personal motivation plus advice given that is causing all these diabetics to not reach the targets. In my own case, I'll freely admit that I was not motivated to look after myself in the past but that's because when I tried to do my diabetes right I found it an uphill battle, I was not taught to carb count or flex my insulin to my food, just a standard x units of insulin per meal (not even x units of insulin and x g of carbs, just x units of insulin per meal whatever!) so I went up and down like a yo yo because my carb intake would differ. So I ended up thinking 'sod it this is far too hard' and gave up. So it's partly my fault and partly the fault of the HCPs, the two are intertwined so it's not as easy as saying it's the fault of one or the other. That's just my case but I'm sure I'm not the only one.

 

[shop]

So it's a combination of personal motivation plus advice given that is causing all these diabetics to not reach the targets. In my own case, I'll freely admit that I was not motivated to look after myself in the past but that's because when I tried to do my diabetes right I found it an uphill battle, I was not taught to carb count or flex my insulin to my food, just a standard x units of insulin per meal (not even x units of insulin and x g of carbs, just x units of insulin per meal whatever!) so I went up and down like a yo yo because my carb intake would differ. So I ended up thinking 'sod it this is far too hard' and gave up. So it's partly my fault and partly the fault of the HCPs, the two are intertwined so it's not as easy as saying it's the fault of one or the other. That's just my case but I'm sure I'm not the only one.

I have been excactly the same. Carb counting has given me control. I am having problems with hypos due to hormonal fluctuations which means that I am having to change by Basal every few weeks. Initialy went by the 3 day rule. But DSN says I must reduce by 3/4 units going down and try 1/2 units going up. ( feel like I am chasing my tail with dose adjustments, I had 1 1/2 weeks of Hypos 2/3 a day then highs because had reduced so much and hormones had changed again!!! ) But have no choice but to keep trying. I am going back to my GP re the hormones and am trying to work it out with my DSN. Not ideal and have felt very frustrated. But I couldn't be doing more and am more focused than I have ever been.

I could see that my DSN was concered that my lows followed by highs would affect my HBA1C. He too a copy of my self altered sheet ( designed to easily see patterns.)

I will not give in!!!

Lucy.