Official HbA1C Treatment Targets

Antje77 said:

For some type1's that's perfectly possible. Not entirely sure I'm a type1, but I am on mdi, so high risk of hypo yet I've never needed help for a hypo, and the lowest hypo I've had in the last month was 3,2, and that was only once. Last a1c was 42, should be a bit lower right now. I guess I'm lucky in that my diabetes behaves pretty predictable. Problem is that a lot of HCP's believe you have hypo's all the time when you have a nice low a1c. Glad I have the meter to prove otherwise.

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I second what @Antje77 has said. Think my lowest has been 3.7. My only three HbA1cs since going onto MDI were 38 35, and 38. I expected my GP to be spooked and warning about hypos but that didn't happen. Honestly don't think I could have done that without low-carbing. Hats off to those who do manage it on higher carbs.
Geoff

Grateful said:

It is rather interesting that both the U.S. and U.K. guidelines, which are supposed to be followed by doctors, plainly mention the possible option to treat with diet/lifestyle alone. Yet, in both countries, it seems that option is seldom "prescribed" as an initial course of treatment by doctors, for those patients whom it might benefit. Or at least that is the impression I get.

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An HbA1c target of 7% (53) is a ‘population’ level benchmark which is used to (1) assess the quality of long-term glycemic control and (2) to guide medication adjustment. 7% was chosen as studies have demonstrated that the vascular complications of diabetes occur above this level.

In the UK, the relevant targets are the NICE QOF targets: https://www.nice.org.uk/standards-and-indicators/qofindicators?categories=&page=2, and in the US your physician is likely following the NCQA targets: http://www.ncqa.org/programs/recognition/clinicians/diabetes-recognition-program-drp, based on the ADA best practice recommendations.

So, population level metrics are used in both the UK and the US to determine the quality of care a practice provides for their patients with diabetes; funding is always tied to achieving the quality metrics in both countries. The rationale being ‘why waste funding on ineffective care?’ Fair enough.

But, if population level metrics drive treatment decisions, then treatment will very quickly escalate if an individual fails to achieve the target HbA1c metric after 3 months of lifestyle interventions. Escalating treatment more or less guarantees that the target metrics will be met.

And, how much education and support is given to newly diagnosed patients, and what is the caliber of that education or support? It is important to remember that those of us who have managed to control our condition with lifestyle measures are outliers; we do not appear in the medical literature. Our physicians do not see many patients like us, they do not read about us in their journals. So, unless they are willing to take a radically different approach to management as Dr. David Unwin has done so successfully, they will escalate treatment according to the guidelines – so that their practice/surgery will achieve the quality metrics and be paid accordingly.

Is it any wonder that lifestyle measures get the short shrift?

librarising said:

I second what @Antje77 has said. Think my lowest has been 3.7. My only three HbA1cs since going onto MDI were 38 35, and 38. I expected my GP to be spooked and warning about hypos but that didn't happen. Honestly don't think I could have done that without low-carbing. Hats off to those who do manage it on higher carbs.
Geoff

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Thanks for taking your hat off I'm moderate carb, I think. Probably between 60 and 150 gr carbs a day, but very different each day. I'm a lousy carb-counter but apparently a talented insulin-guesser. Let me take my hat off for you in return : I would find it very hard to keep to a real low carb diet and seriously count them!

ringi said:

Most people with Type1 and a HbA1c of 48 would have been in hopical with hybos a few times! I don't think it can be done without controling the peaks to an extend that is not possible using the methods the NHS teach people.

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Type 1 here with an HbA1c of 29, never needed to go to hospital due to diabetes. In fact my blood sugar has not been below 3.9 for over a month now. I eat a moderate carb diet (100-150g per day) and use a pump and CGM, my doctor is very supportive of my treatment decisions.

@phdiabetic With numbers like that, how did you get a pump and CGM?

ringi said:

@phdiabetic With numbers like that, how did you get a pump and CGM?

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I don't know why I shouldn't get a pump/cgm with those numbers...generally you need to demonstrate good control to be eligible for a pump in the first place, so I'm not sure why you're surprised that I got one.

My endo and I discussed my options and decided that a pump would be helpful due to the small doses and ability to adjust basal at different times. My health insurance funded the pump since I met the eligibility criteria. I got a CGM and initially paid for consumables but at the moment I am receiving fully subsidised consumables due to government funding.

phdiabetic said:

I don't know why I shouldn't get a pump/cgm with those numbers...generally you need to demonstrate good control to be eligible for a pump in the first place, so I'm not sure why you're surprised that I got one.

My endo and I discussed my options and decided that a pump would be helpful due to the small doses and ability to adjust basal at different times. My health insurance funded the pump since I met the eligibility criteria. I got a CGM and initially paid for consumables but at the moment I am receiving fully subsidised consumables due to government funding.

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Sorry I did not release you were outside of the UK, as in the UK pumps are only given to people when it is expected to reduce the lifetime cost of their health care. (You may have qualified in the UK based on doing small doses many times a day.)