Guidelines

How do you feel about a hba1c target of 6.5%? Chatter among the #DOC this week has been circling the new NICE (National Institute for Health and Care Excellence) guidelines for people with diabetes in the UK. I initially felt quite reactive to this like many others on social media, however some rational thinking has softened my view.

In Australia, I’ve always been told that I should strive for a hba1c of between 6 and 7%. That hasn’t changed in the 5 years that I’ve lived with diabetes. During that time, my hba1c has plummeted due to frequent hypoglycemia, it has gone up due to burnouts and it’s also fallen within the satisfactory range. And I can tell you from experience that a satisfactory hba1c level is extremely difficult to maintain while trying to live an active and ever changing life.

My main concern about this suggested target is that each and every person with diabetes is different. And we all have our own unique circumstances surrounding our diabetes. There are children, teenagers and adults living with diabetes. Some of us are newly diagnosed, while others have been living with it for several years. Some of us have a parent or carer to help us manage diabetes, while others do it on their own. Some of us are content with where we are at, while others are fine tuning and making room for improvement.

So, in that respect, a stock standard number for the masses is certainly not a one size fits all approach. That number will be easily achieveable for some, and completely unrealistic for others. That number is going to set some up for success after success, and others up for repeated failure. And while a number is a great means of motivation and goal setting, it isn’t always a true reflection of the hard work and effort we’ve put in to managing our diabetes.

On the other side of the argument, Mike at Everyday Ups and Downs points out that the lower target is a way of encouraging us not to settle for something satisfactory. I’ve been really excited at seeing borderline acceptable hba1c levels in the past, only to be told by doctor’s that it should be lower. My response at the time was more than dismissive, but looking back at it today, I finally get it. I should strive for a lower number if it’s a realistic goal for me, as it will further reduce my risk of complications in the future.

Mike also suggests the 6.5% target is a way of making doctors more comfortable with seeing lower hba1c numbers in patients. It’s news to me, but apparently some non-hypoglycemic patients are told that their hba1c levels are too low. Crazy!

So, what do I think of all of this? Don’t pay too much attention to what’s in the media or to others. Set your own goals that cater to you and your diabetes situation. Make them realistic. Have a team of people around to cheer you along. Take some time to relish an achievement, and then move the goalpost a little further back. And remember that nothing is impossible if you put your mind to it.

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