# Study: No benefit of HbA1c < 6.5% for T1D's



## Eddy Edson (Sep 6, 2019)

https://www.medscape.com/viewarticle/917865

_A target HbA1c level of 6.5%-6.9% may be preferable to aiming below 6.5% in adults and children with type 1 diabetes, new research suggests. 

The findings, from more than 10,000 children and adults with type 1 diabetes diagnosed between 1998 and 2017 from the Swedish National Diabetes Registry, were published online August 28 in the BMJ by Marcus Lind, MD, PhD, professor of diabetology at the Institute of Medicine, University of Gothenburg, Sweden, and colleagues.

From diagnosis through 2017, among individuals who achieved HbA1c < 6.5% (< 48 mmol/mol) compared with 6.5%-6.9% (48-52 mmol/mol), there was no reduction in risk of diabetic retinopathy or nephropathy, but there was a significantly increased risk of hypoglycemia at levels < 6.5%.

Severe complications most commonly occurred at much higher HbA1c levels, above 8.6% (> 70 mmol/mol), and milder complications began to increase above 7.0% (53 mmol/mol).


Overall, Lind and colleagues write: "The current findings support a general target of HbA1c < 7.0% in people with type 1 diabetes. People who achieve HbA1c levels < 6.5% should be vigilant about not spending too much time in hypoglycemia and achieve a good diabetes-related quality of life."_


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## Bruce Stephens (Sep 6, 2019)

The report did note that CGMs (and FGMs) might reduce the risk of hypos. (Though going below 48 would still presumably provide little benefit, at least for retinopathy and nephropathy.)


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## everydayupsanddowns (Sep 6, 2019)

Similar to the data we reviewed for the 2015 NICE guideline, though if I remember right there was evidence of a slight improvement in retinopathy risk below 6.5%.

Interesting to combine these findings with the international consensus on Time in Range from continuous sensors.

https://forum.diabetes.org.uk/boards/threads/time-in-range-useful-for-libre-cgm-wearers.82080/


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## TheClockworkDodo (Sep 6, 2019)

Interesting, thank you @Eddy Edson - I think my last one was 48, and I've usually been around 48-53.  Still have huge numbers of hypos though, I don't seem to be able to do anything about that.  And thanks Mike for the link to the other thread, I somehow missed that before.


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## nonethewiser (Sep 7, 2019)

Enlightening,  many years back consultant said keep below 7 with as few hypo's as possible, seems they were right all along.

 everydayupanddowns is on the money, time in range is a better indicator of good control.


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## mikeyB (Sep 7, 2019)

If folk think that getting their HbA1c below 6.5% will prevent retinopathy, they are mistaken. There isn’t any hard evidence that retinopathy is _directly_ related  to HbA1c, unlike other diabetic complications. The evidence for that is simple - not every person with diabetes gets retinopathy. Some folk get it early in their diabetic journey, some folk late, some folk not at all. There are many other factors in play, including whether you are T1 or T2.


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