What is your GP/DN HBA1c target

[RobsterinSheff]

Hi everyone

I am interested in the varied practice out there for what each of our individual HBA1c target ranges are- and any explanations/ reasons for setting the target in a certain way.

A couple of weeks ago my latest A1c was 6.4/ 46 so my GP immediately halved my metformin from 2000 per day to 1000 per day.

He said it was because the "target for T2D should be tightly controlled within the range 48 and 53" (6.5- 7.0 in old money): reason/ excuse being a so-called U-shape in the CvD 'endpoints (!) of diabetics that mean risk is raised both if you are above 53 and below 48!

I am in Sheffield: my Mum is also T2D and she is in Bristol. Her test last week was 42 (6.2) and she was actually told off slightly by her HCP as they "target 20-42 and are not happy if you are above that" !! She was most upset as she has a slight bowel reaction to metformin and was hoping to get it reduced like myself. Instead they were insinuating the dose might have to go up again if this 42+ continues.

I have seen others on here say their GP target is 48-58 (6.5 - 7.5) and others swear blind that you must aim for an HBA1c of less than 5.4 (36) as an absolute ceiling.

So I am just interested in people giving the ranges that their GP/DN has set and/ or their own personal target range if the latter differs from the former.

 

[didie]

The first time I saw the Diabetic Nurse she told me to aim for 7.0. I haven't seen her again as I prefer to see my GP who I feel is more supportive.

My GP just said the lower the better with no set figure and is absolutely delighted with my results.

 

[l0vaduck]

I'm type 1 so it's probably different, but my clinic tell us to aim for between 6 and 7. They reckon that under 6 means you're likely to be risking hypo unawareness. I'm not convinced of this and have in the past managed to achieve 5.4, but that was with really obsessive control and monitoring. My norm is inside their target range.

 

[MaryJ]

Mine said below 48 (6.5%) with no lower number mentioned

My last one was 36 and the receptionist was delighted with me lol.

Mary x

 

[ButtterflyLady]

I've always hovered between 6.1-6.4 and I get the feeling my doc would be fine with anything under 7. I'd like to get it as low as I can, and I don't think I will be able to get it lower than say 5.5, just because it is too hard for me to control my carbs and get exercise. I have other conditions that interfere with diabetes management so I just try to do my best.

I'm very big on patients rights and if a doctor arbitrarily halved my metformin dose against my wishes I'd find a new doctor. But I know its hard to do this in the UK. I feel for you peeps over there.

 

[Meg2009Arm]

My doctor told me that my HbA1C was excellent at 6.2% however I was on a pretty restrictive low carb diet on metformin and sitagliptin at the time and loosing far too much weight (BMI 0f 17) She obviously thought I was being obsesive as I told her I kept to a low carb diet and was told 'I needed to eat more potato's'!! Also was told that there was no health gain in getting it below 6. I disagree however I am on insulin now and frequently have hypo's or would do if I wasn't snacking on fruit regularly. It's so hard to get the balance right.

 

[dawnmc]

Mine have never said a thing about what I should be aiming for. In fact I've never seen a GP for diabetes.

 

[Daibell]

Hi. Probably the best advice is to look at the latest (June) NICE Pathways for Type 2 and the web link is:

http://pathways.nice.org.uk/pathways/di ... 2-diabetes

This gives 7.5% as the level to stay below or as it says 'or agreed target'. 7.5 is quite high so best to stay below 7'ish if possible. My result today was 57 mmol (7.3'ish so is getting very near the limit)

 

[xyzzy]

He said it was because the "target for T2D should be tightly controlled within the range 48 and 53" (6.5- 7.0 in old money): reason/ excuse being a so-called U-shape in the CvD 'endpoints (!) of diabetics that mean risk is raised both if you are above 53 and below 48!

Yes he's talking about this "Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study"

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(09)61969-3/abstract

The study was later trashed as it included a bias towards overweight uncontrolled insulin using T2's. When that bias was removed the U shape miraculously disappeared. A mention of its refutation is given in this Swedish Healthcare doc.

http://www.healthcare-bulletin.com/...ascular_Disease__in_Diabetes_Care_-_2011_.pdf

A recent observational UK General Practice Research Database (GPRD) study has reported increased risk of total mortality with lower HbA1c with lowest risk for HbA1c 7.5%, and also a 49% higher risk of total mortality with insulin treatment versus oral agents. However, this was not verified in the NDR study, showing no J-shaped risk curve for total mortality in patients treated with insulin or oral agents, and that the increased risk of total mortality with insulin was due almost exclusively to an increased risk of non-CVD mortality, and that HbA1c was not at all associated with non-CVD mortality.

I think I have read that newly diagnosed T2's who have no additional risks are now told to aim for 6.5% because the risk of retinopathy begins to increase above around 6.5%. For example look here http://medweb.bham.ac.uk/easdec/prevention/hba1c_and_retinopathy.htm

Ideal Targets for HbA1c

if well, and diet or tablet controlled HbA1c less than 6.5%

As to my own DSN she politely ignored my request to write down my requested target of 4.8% as she says anything under 6.5% is brilliant. I am actually inclined to agree with her as its that 6.5% level that diagnoses you as diabetic so anyone who gets under 6.5% is doing really well.

 

[Mileana]

I'm type 1.5 on insulin.

Danish guidelines are below 6.5 for Type 2s, below 7.5 for Type 1s or people on insulin.

My own target is currently getting a HbA1c that corresponds with an average blood sugar of 6 or below, which I believe would mean 5.2 percent. I am having trouble getting there though, which surprises me a lot with most my readings below 6 and a fasting blood glucose of <5.0 mmol, but I am told it may have to do with my abnormal red blood cells.

I try to trust the things I measure and avoid any spikes above 7 whenever I can. I don't drag low carb food with me everywhere, though, so sometimes it goes above.

Personal preference for me due to various weight, intolerance and mood issues - I prefer ketosis, it keeps other things in check.

 

[noblehead]

Diabetes team are happy if type 1's get below 7.5, when I came here I wanted to get around 6 and currently sitting at 6.4..... so quite happy at that.