# Study suggests new HbA1c ‘sweet spot’ to reduce risks of complications in type 1 diabetes



## Northerner (Oct 9, 2019)

Scientists from the universities of Gothenburg and Linköping in Sweden have suggested a new HbA1c ‘sweet spot’ in order to minimise the risk of complications in type 1 diabetes.

Findings published in the British Medical Journal showed that the risk of complications associated with type 1 diabetes can be kept to a minimum by maintaining an HbA1c below 7% – although having an HbA1c lower than 6.5% was associated with an increased risk of severe hypoglycaemia and severe retinopathy.

As many people with type 1 diabetes spend time and effort to keep their blood glucose at or below the recommended 6.5% target in order to avoid complications, these findings suggest people achieving an HbA1c between 6.5% and 6.9% can also avoid increased risks of complications.

https://jdrf.org.uk/news/hba1c-minimise-risks-type-1/

Interesting that frequent hypos can contribute to retinopathy - hadn't heard that before. I wonder what they define as 'frequent'? This effectively suggests that the tightrope just got narrower - a mere 0.4% range to aim for


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## Bruce Stephens (Oct 9, 2019)

Northerner said:


> these findings suggest people achieving an HbA1c between 6.5% and 6.9% can also avoid increased risks of complications.



Which is 48 to 52 in mmol/mol. (I wish everybody would make up their minds which units to use, and then use them consistently.)


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## everydayupsanddowns (Oct 9, 2019)

This is pretty meaningless I think. 

I had far more hypoglycaemia (including severe hypos) at 7+ than I have had between 5.9 and 6.8. Current guidance for “support PWD to aim for 6.5% (48) or below” includes plenty of caveats about hypo risk. But it’s not as inevitable at lower A1cs as is almost always assumed.


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## mikeyB (Oct 9, 2019)

I agree, time in range works for me. I don’t know what algorithm the Libre uses, though. It’s predicted HbA1c is always worse than it really is, in my experience, though time in range is clearly accurate.


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## everydayupsanddowns (Oct 9, 2019)

mikeyB said:


> I agree, time in range works for me. I don’t know what algorithm the Libre uses, though. It’s predicted HbA1c is always worse than it really is, in my experience, though time in range is clearly accurate.



Interestingly I always find Libre’s predictions a little optimistic and slightly lower than the lab tests I then have. #YDMV etc.


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## SB2015 (Oct 9, 2019)

Northerner said:


> Scientists from the universities of Gothenburg and Linköping in Sweden have suggested a new HbA1c ‘sweet spot’ in order to minimise the risk of complications in type 1 diabetes.
> 
> Findings published in the British Medical Journal showed that the risk of complications associated with type 1 diabetes can be kept to a minimum by maintaining an HbA1c below 7% – although having an HbA1c lower than 6.5% was associated with an increased risk of severe hypoglycaemia and severe retinopathy.
> 
> ...


An interesting report.

Whatever they say all we can do is the best that we can with the resources available to us.  As others have said, it seems to make far more sense to focus on time in range as that shows much more than a ‘simple’ (I know that it is a weighted average due to not being a linear scale of destruction of cells) average taken over three months.  I know mine used to hide massive spikes after meals before I started to adjust the timing of my Bolus, and lots and lots of hypos.


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## Bruce Stephens (Oct 9, 2019)

SB2015 said:


> An interesting report.
> 
> Whatever they say all we can do is the best that we can with the resources available to us.



It's the same Swedish report we discussed a little while ago, I think. And yes, they comment at the end that the patients almost all had been using conventional test strips rather than CGM (or FGM), and suggested that it might be that with continuous monitoring it would be safer to aim a little lower.

Maybe it still wouldn't be worthwhile, of course; my guess is that at a larger scale you'd be aiming to get more people 48-52 (and keeping with the time in range goals), likely with less effort than with test strips rather than trying to get many people lower.


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## Lizzzie (Oct 9, 2019)

Interesting.   I always kept to.the guidelines and was very proud of my low blood sugar until I accidentally got it wrong one night, suffered significant brain damage and have been struggling with cognition ever since.

So my sample size of one fits consistently with these findings.  Dexcom is brilliant but I find it psychologically restrictive.


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## nonethewiser (Oct 10, 2019)

Sweet spot not beyond the realms of possibility, provided the tech is handed out more freely, libre is a game changer for sure.

Consultant is more new school, more interested in time in range than Hb unlike previous, but depends on what the parameters are for that time in range, no good having high % if goals are set to high low.


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## mikeyB (Oct 10, 2019)

Benny G said:


> Were you using your dexcom when you had your bad hypo?
> Personally I find libre and cgm to be psychologically liberating.


Couldn’t agree more, I feel much more relaxed with the Libre than I ever did with test strips.


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