Does anyone understand why the NHS defines an HBa1c of between 48 and 58mmol/mol as 'satisfactory' for people diagnosed with Type 2 when this is so far over a healthy level and will be damaging your body? I asked my last GP and he did not have an immediate answer. After a long pause he said that he thought people were not expected to be able to achieve a healthy level. I find this very strange as you would think the aim of medicaiton would be to lower blood sugar into a healthy range? have recently managed to get my level to 44mmol/mol and my new GPs response was to say she needed to stop one om my medications. I pointe out that it was still not in a healthy range and I had only achieved it while on medication and would not want it to go back up again. I would love to reduce my medications but not at the expense of having higher blood sugar levels again.
I think there's a few things going on. One is that the NICE guidelines don't really cover anything except drugs treatment, and you could be forgiven for thinking there was no alternative. The other is that there seems to be zero expectation that things will ever get any better. Only slowing the inevitable BG rise with more and different drugs.
The relevant section of the guidelines for 'what a patient's HbA1c should be' is this one-
1.6.7
For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of 53 mmol/mol (7.0%).
[2015]
1.6.10
If adults with type 2 diabetes reach an HbA1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it. Be aware that there are other possible reasons for a low HbA1c level, for example deteriorating renal function or sudden weight loss.
[2015]
The guidelines seem to express a fear of any potential for a hypo episode, and taken with the general acceptance that drug treatment is the only treatment. For me, had I paid any attention to these recommendations, this would have meant staying at BG levels that were causing a range of nasty symptoms. There is no thought anywhere of the impact of the recommended levels on the patient. Obviously, hypos are to be avoided, but it's strange that this seems to be the main consideration. I don't know why I should be expected to be having hypos at BG levels that are well above normal.