HbA1c targets…

Talk on Social Media this morning has been mostly about next years NICE guidelines (or the latest draft of them), particularly pertaining to Continuous Glucose Monitoring (CGM) and HbA1C targets.

It seems that more criteria are being set within the new NICE guidelines to try and encourage service providers to use CGM’s in more situations – which can only be a good thing.

More importantly, it seems that a new target of 6.5% for a child’s average HbA1c level might be introduced. The current target is 7.5%. Apparently, only 3% currently achieve the 6.5% level. As we are one of those 3%, I thought I’d blog this morning about how (we think) we do it….

– Disclaimer – This is not an attempt to blow our own trumpet…. More an example that it can be achieved.

We have been using a Dexcom CGM for nigh on 3 years now. We self fund and made the decision to go down this route 6-9 months after Samuel had been given his Roche Accuchek Combi Insulin pump. He has been diagnosed just over 4 years now, so apart from the first three months when he was on multiple daily injections (MDI), his care has always been pretty cutting edge. This is largely down to the support team at Bassetlaw Hospital, who have been excellent. They had us carb counting from day 1 – he was on a pump within three months, and we continued to ride the technological wave by self funding on the Dexcom. We meet our Diabetic Specialist Nurse (DSN) and Consultant quarterly and see a nutritionist annually.

All of these things I mention because they are the building blocks on which Sam’s care is based. Having these tools in place enables us to do the thing that I believe keeps his HbA1C where it is, whilst not having lots of severe hypo’s.

That ‘thing’ is micro-managing…. We (Samuel, Nikki and I) are always much more aware of where Sam’s BG’s are, because it’s just a quick glance on the Dexcom screen rather than going through all the rigmarole of getting the meter out, pricking his finger etc… For a 15 year old teenager, to be constantly asked by your parents… “What are your bloods?”, “How were your BG’s today?”, “Are you low?”… etc – well, thats going to get pretty annoying! The easy thing for Samuel is just to glance at the screen and he can shut us up! He’s learned to trust it, and 95% of the time its bang on.

It’s a subtle thing but very important. Many parents talk about burn out. Many teenagers want to rebel against their T1. The Dexcom allows us to keep the management more in the background, without sacrificing his level of care.

To have a similar level of control without CGM would require at least 15 blood tests per day (and more when exercising, doing exams, during illness etc). That number of finger pricks doesn’t bear thinking about now, although we were averaging that level for a time (before CGM). I firmly believe we’d have dropped back to below 10 a day, just to take the constant pressure off Sam of always having to check. What teenager wants that? But then the level of control would decrease. The number of highs would increase, so would the number of hypo’s and as control diminishes, the dreaded HbA1c goes up….

The CGM allows you to take that pressure off, so tight management isn’t such a drag and more achievable.

It’s like anything in life – people will do it better if it’s easier to do it better!

If more people had access to CGM’s, then from our experience, more people would be able to get their average HbA1C to 6.5% or below. The 3% would increase….

Trying to get everyone to 6.5%, well that’s a huge challenge…

To do it without a CGM? I can’t see how its possible….