Why such high targets?

[hanadr]

I researched this question a while ago, because I couldn't see why targets for BG and Hba1c should be so much higher for diabetics than non-diabetics. It still doesn't make medical sense.
What I found was that:
historically in the USA, a diagnosis of diabetes made keeping in employment difficult and getting health insurance near impossible. since this is disastrous for individuals under US systems, It was decided by medics and the ADA to set the diagnoses targets so high that there was no doubt whateever. this also prevents people from arguing that there's actually a range of possible results and interpretations.
The only difficulty is why hasn't this all been revised down much more, since even the US now has something approaching descrimination laws.
Hana

 

[NickW]

I don't know the answer, but I completely agree with your sentiment.

Even as a type 1 I'm aiming for sub-6 for definite and ideally sub-5.5 - this is well below the targets suggested by the NHS, Diabetes UK, ADA etc. but I honestly can't see why. T1's have to be careful not to achieve good HbA1C's by running constantly low and having too many hypos, but aiming for 7 or 7.5 is downright dangerous.

For T2's, I can't see any reason at all not to aim for non-diabetic ranges - not saying that it's easy to achieve that, but I can't see any harm in making that the ideal goal.

Would be interesting to know what the logic behind it is.

 

[timo2]

The fact that the NHS reportedly spends £15 million each year treating severe hypoglycemia must surely be a consideration for the target setters.

What we need is a dietary approach which gives tighter control AND reduces the incidents of low blood sugar. :?

 

[sugarless sue]

For T2's, I can't see any reason at all not to aim for non-diabetic ranges - not saying that it's easy to achieve that, but I can't see any harm in making that the ideal goal.

For someone newly diagnosed with type 2 , especially with high numbers , a target in the non diabetic numbers would be like shooting for the moon!!

For those of us long diagnosed and more experienced then lower numbers are easier to achieve.

The NICE guidelines,while not ideal, are at least achievable for newly diagnosed or less experienced members.
However once you do achieve those numbers and have more experience controlling your diabetes then trying for the lower numbers may be something else to achieve.

 

[NickW]

For someone newly diagnosed with type 2 , especially with high numbers , a target in the non diabetic numbers would be like shooting for the moon!!

Absolutely, I'm not suggesting we should be aiming for perfection off the bat! But the current message is basically that A1C's of 6.5% are perfect and under 7 is good; I'd rather the message was that 6.5 is a great initial target but with the knowledge that there's more work to be done.

I guess it's a case of setting expectations from the off; I wasted years after my diagnosis with an A1C's in the 7's and thinking I was fine because that's the advice I was given. Had I been told from the outset that sub-6 was a worthwhile aim I would have worked harder. Who knows what damage I've done to myself over the course of those years running with high A1C's? I'm thankful that I have no complications so far, but it could easily have been very different.

 

[cugila]

The current NICE guidelines for a T2 regarding HbA1c levels is as you rightly say 6.5%.
A target figure. Something to aim for. Now it doesn't tell anybody that 7% is OK ?

What it does say is this:
Involve the person in decisions about their individual HbA1c target level, which may be above that of 6.5% set for people with type 2 diabetes in general.

Nothing to stop anybody stating that they want to get below that target figure either ? My stated aim was to get below that target figure. Nobody has tried to stop me or told me that is not allowed ? There are guidelines everywhere you look nowadays, doesn't mean you have to stick to them. The medics seldom do. It is the interpretation of these guidelines that is flawed, same as the dietary advice. Total fiction. About time that was changed, but of course, nothing happens overnight.

It also states this:
inform a person with a higher HbA1c that any reduction in HbA1c towards the agreed target is advantageous to future health.

Now, everybody seems to read into those guidelines that a higher level is advocated ? It clearly states that any reduction in the agreed target is advantageous. Now my target level was put lower than the target of 6.5% HbA1c. So the figure is flexible, if you want it to be ?

My particular Endo and many of his colleagues don't go along with the 6.5% They advocate that the levels should be lower if the Patient can get there. In my view a proper interpretation of the guidelines. What he also has said is that not everybody is able to achieve those levels without much sacrifice and that can be detrimental to their overall health. There are many members on here with multiple health issues who are just glad to be within the NICE guidelines. Rightly so. They are feeling so much better and are even managing to reverse symptoms. Once they get there then there is no reason to hold them back and we then try to get them even better control. A lot get that control but for some sadly it is not attainable. We are all different and we also have other things in life that matter besides our diabetes.

Everybody on this site encourage them to get the numbers down, but not so fast that it becomes a chore, a struggle. Lifestyle change are far better than some headlong rush towards some numbers which to some are just plain unachievable ? Give them time and they will get to their goals.

Stating that the goal at the outset should be non-diabetic numbers is just unrealistic. Some will never do it, they haven't the willpower or the motivation. They can't afford to fund their meters and test strips. They can't afford the new foods that they will inevitably try to feed the rush for these non-diabetic numbers. It is just plain daft to say that because you can get those magic numbers everybody can. We can all strive for that perfection, but sadly, not everybody will make it.

When I came here I was encouraged to take control of my Diabetes. That's what I did. Nobody told me that I should strive for non-diabetic numbers, they just helped me to see what I was doing wrong and helped me to lower them bit by bit. By doing that, I never lost heart, I never faltered. They gave me the willpower to carry on and strive for better things. As Sue say's they never told me to shoot for the moon, just take it one step at a time ? Those same people are now over in another forum, they still post here as well. There were some that did advocate non-diabetic numbers but I discounted them as they were in a minority.

I'm fortunate in that my health care team don't stick to the guidelines because as they say, they are open to interpretation. Pity some others can't see that they are not the Ten Commandments and cast in stone !!

So, I think the targets are OK. But I definitely want to beat that target, that's because I have a competetive nature and plenty of willpower. It is the HCP's that need the education and pushed to accept that guidelines are just that. They can be bettered without a detrimental effect. That's my opinion for what it's worth.

 

[valattrevear]

Cugila, an excellent post, telling me that these magic numbers should be aspirational and not what is expected of me is such a great outlook I am happy with every reduction I get, and the idea that the magic "5" may not be easily achievable for everyone is an incentive to do the best I can without beating myself up if I don't get to the fives. How many people will not accept that guidelines are exactly that, a guide! Thank you!
Val