NICE guidelines & HbA1c testing

Atad heavy said:

I have also never seen my GP about diabetes, the diabetic nurse saw me for my diagnosis too. I wish that I could say the same for being brilliant & knowledgeable perhaps I do need to move to another surgery.

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A friend of mine did that, hoping for a second opinion, but met the same HCP in the new surgery since both practices used a Bank agency who employed her. Quite often nurses with specialist skills are either Bank or Contract since they get better pay that way. My sister does this.

I think most comments on this thread are from people with type 2.
Maybe the view from someone with type 1 may be interesting for someone reading this thread in the future. I have no intention to derail the thread but understand the OP has type 2.

When I was first diagnosed, I had my Hb1AC tested at 3 months, 6 months later, and ever since approximately 14 monthly to coincide with my annual diabetes review which is always late.
As my diabetes is treated with insulin, I have always had test strips and, very recently, Libre. With strips, I test more than 8 times a day (the reason I qualified for the Libre).
My diabetes is very much self-managed. The main reason I attend the annual review to get the results of my liver and kidney function which is done at the same time as the Hb1AC and cholesterol. It is also a chance for me to ask the chance of getting the latest pump, etc from the CCG.
If between reviews I see my BG rising, I have the tools I need to adjust my insulin dose and bring my BG down.
My diabetes team know I have the skills and knowledge for this and see no reason for additional tests, appointments and cost to the NHS. I agree wholeheartedly.

For people with type 1, I believe the NHS money is better spent providing the tools and education to self manage rather than constant testing.
This, of course, requires the patient to believe in the value of these tools. If they don't, I am not sure 3 or 6 monthly Hb1AC testing will help with motivation. Although the time spent with the doctor may ... if they turn up to the appointments

With type1 (like type2) without a regular A1c the health service dose not know who needs additional surport include medical health surport for people who have stopped caring. It is likely that a A1c is cheaper then a HCP looking at someone BG records. Clearly a NHS system when everyone uploads Libra data to, with AI looking at the results would be better, but we don't have it yet.

@ringi I agree regarding NHS knowing who needs additional support.
It's worth bearing in mind that most people with type 1 have the condition for many years and work with the same dedicated diabetes team. Therefore, the team is likely to be able to work out who needs and will benefit from the additional support within a year or two (when we are, typically, more closely monitored) rather than needing constant monitoring all the time.
And, many CCGs support the upload of BG readings from meters (and Libre) into a system that the DSN can review without the need for another Hb1AC and face to face meeting unless deemed necessary.
Not that I am suggesting my DSN (who I first saw over 15 years ago) is an AI. She is very human and incredibly supportive when I need it.

I have just been approved for Libre on prescription. This requires a 6 monthly review of the results which are automatically uploaded. This is probably more useful than Hb1AC.

I believe an annual review for everyone with type 1* is necessary to consider the mental impact of the condition. Whilst "bad numbers" may indicate mental health issues, there are other reasons so I don't think a computer can tell by looking at graphs; human interaction is needed. Just not as often as every 6 months for everyone.

*This may also be true for someone with type 2 but I do not have the knowledge and experience to comment.

Atad heavy said:

They must have changed those guidelines because my surgery were adamant that that is how often it is done now. I am going to discuss this with my Dr as I feel it’s so important.

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That appears to be the most up to date guidance so it should apply.

helensaramay said:

I believe an annual review for everyone with type 1* is necessary to consider the mental impact of the condition.

*This may also be true for someone with type 2 but I do not have the knowledge and experience to comment

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The annual reviews I have experienced so far with type2 have been little more then box ticking, but that may be because it was all I needed.

I have doubts about the benefits of the A1c for anything more than a quick glance at by the diabetic nurse, as I find they rarely correspond with my home blood tests. My last three A1cs have been 29, 29 & 30, which puts me firmly in the non-diabetic range. My finger pricks tell a different story with my 90 day average being 6.9. No-one has been able to explain the difference (29 equates to about 5.0). I'm happy enough at 6.9, though, and I've pretty well given up trying to work out why.

Injebreck said:

I have doubts about the benefits of the A1c for anything more than a quick glance at by the diabetic nurse, as I find they rarely correspond with my home blood tests. My last three A1cs have been 29, 29 & 30, which puts me firmly in the non-diabetic range. My finger pricks tell a different story with my 90 day average being 6.9. No-one has been able to explain the difference (29 equates to about 5.0). I'm happy enough at 6.9, though, and I've pretty well given up trying to work out why.

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Given that a home BG only has to be within 15% of true BG for 85% of tests, and hence is allowed to be totally wrong for over 10% of users all the time, provided it works well for the other users.

Injebreck said:

I have doubts about the benefits of the A1c for anything more than a quick glance at by the diabetic nurse, as I find they rarely correspond with my home blood tests. My last three A1cs have been 29, 29 & 30, which puts me firmly in the non-diabetic range. My finger pricks tell a different story with my 90 day average being 6.9. No-one has been able to explain the difference (29 equates to about 5.0). I'm happy enough at 6.9, though, and I've pretty well given up trying to work out why.

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Join the club. There are quite a lot of us on this forum with HbA1cs that in no way resemble the expected level from other monitoring (a home HbA1c test, constant finger pricking, and the Libre sensor) In my case my HbA1c is always significantly higher than expected. If your red blood cells are in short supply, or if they live a lot less than the average 120 day, this could explain your low HbA1c.

Atad heavy said:

Good morning everyone,
My apologies if this post has already been discussed at length, I have tried searching for existing threads but found none.
I was really disappointed to be put on yearly HbA1c tests as I had only been diagnosed as type 2 in October 2018. Now I know why - it’s down to NICE guidelines, this applies to diabetics whether they are on meds or not and the only exception is if your Dr orders a test. This is just sheer stupidity to my mind & a very poor decision. We are warned about the complications of diabetes but I for one, do not have a medical degree so would not necessarily associate new symptoms with possible complications. A year between testing is a long time & it’s very sad that they don’t recognise the importance of this test. For the people who are making lifestyle/diet changes these results can be good motivation to continue & improve.

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Hi there, I'm not a new T2 but recently my Hba1c has shot up to 101 so, I asked my diabetic nurse if we could test every 3-4 month to give me incentive to get it down. She's agreed and the first three months will be up in July so I'm making adjustments now so I can breathe success when the test comes.

BTW, it's great on here, font of knowledge. Good luck then, Q.

Jim Lahey said:

Never mind HbA1c. If you want a lesson in real stupidity then consider the advice handed to most T2s that they should not monitor their own glucose. Preposterous!

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Same here, "what do you want that for" is all I get.

Jim Lahey said:

Never mind HbA1c. If you want a lesson in real stupidity then consider the advice handed to most T2s that they should not monitor their own glucose. Preposterous!

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Yep, I've had that too.