The fallacy of average, why HbA1c isn't good enough

KITLIVING

continued over

scale than just the daily tests, it is an average

,the outcome of which can dictate whether

or not you qualify for CGM or pump therapy.

If your HbA1c is higher than 8.5% then you

are more likely to get access to either of

those more advanced therapies.

In an article written for Insulin Nation by

endocrinologist Claresa Levetan in 2013

clearly states exactly how use of CGM has

totally changed the perception of diabetes

control. Having trained at a time before

even blood test metres were available,

she gamely tried a CGM sensor in order to

compare her own non-diabetic readings

against those of her diabetic patients but

noted, "I learned that comparing A1Cs

for people with and without diabetes was

like comparing apples and oranges. Even

patients who used insulin pumps, ate the

same meals every day, exercised daily

and "did everything right" can hardly hope

to achieve the glucose levels of a person

without diabetes. I realized I needed

to stop blaming my patients or thinking

myself superior."

The fact is that CGM makes the

concept of 'time in range' so much easier

to understand --- the visual nature of

the graph, shown between the two lines

of 'too high' and 'too low' lets you see

how much of your day to spend between

those two parameters, how much time

you have spent in range. It can also show

you how much time you have spent in

hypo (or hyper).

Fallacy of average

A report by several authors including Roy

Beck from the Jaeb Centre for Health

Research based in Tampa, Florida, and

published in May 2017 in Diabetes Care,

the journal of the American Diabetes

Association (ADA), was entitled, "The

Fallacy of Average, How Using HbA1c

Alone to Assess Glycaemic Control Can

Be Misleading."

While the report acknowledged

"HbA1c is a valuable metric for comparing

treatment groups in a randomized

trial, for assessing glycaemic trends in

a population over time, or for crosssectional comparisons of glycaemic

control in different populations, what is

not widely appreciated is that HbA1c may

not be a good indicator of an individual

patient's glycaemic control because

of the wide range of mean glucose

concentrations and glucose profiles that

can be associated with a given HbA1c

level."

In order to prove this point, the

authors plotted mean glucose measured

with continuous glucose monitoring

(CGM) versus central, laboratory-

measured HbA1c in 387 participants in

three randomized trials, showed that not

infrequently HbA1c may underestimate or

Even patients who used insulin pumps, ate the same meals

every day, exercised daily and "did everything right" can

hardly hope to achieve the glucose levels of a person

without diabetes. I realized I needed to stop blaming my

patients."

overestimate mean glucose, sometimes

substantially. Thus, if HbA1c is to be

used to assess glycaemic control, it is

imperative to know the patient's actual

mean glucose to understand how well

HbA1c is an indicator of their actual

glycaemic control. With knowledge of the

mean glucose, an estimated HbA1c can

be calculated.

Estimating glycaemic control from

HbA1c alone is in essence applying a

population average to an individual, which

can be misleading. Thus, a patient's

CGM glucose profile has considerable

value for optimizing his or her diabetes

management.

In this era of personalized, precision

medicine, there are few better examples

with respect to the fallacy of applying a

population average to a specific patient,

rather than using specific information

about the patient to determine the optimal

approach to treatment.

Crowd power

But it's not just been doctors and

researchers moving this concept forward,

this idea gained true momentum in the

user-base, us - people with diabetes

wanted a better way of looking at how we

were doing.

Index

  1. Desang diabetes magazine diabetes information
  2. Dexcom CGM, continuous glucose monitoring
  3. Desang diabetes magazine diabetes information, Sue Marshall
  4. Desang diabetes magazine diabetes news
  5. Diabetes UK Nutrition Guidelines, Medtronic insulin pump CGM packages
  6. Verily, CGM for T2, Medical ID jewellery, Ascensia Diabetes Challenge
  7. Leicester Diabetes Centre, JDRF, Rachel Connor JDRF, T1Exchange
  8. Diabetes kit diabetes management equipment
  9. Omnipod Insulet insulin pump with insulin pods
  10. Desang diabetes magazine diabetes diet
  11. Desang diabetes magazine diabetes diet
  12. Accu-Chek Mobile blood glucose system
  13. Accu-Chek Mobile blood glucose system
  14. The tyranny of HbA1c time to talk now about Time in Range
  15. The fallacy of average, why HbA1c isn't good enough
  16. ADA Consensus Report Outcome Measures Beyond HbA1C for Type 1 Diabetes
  17. hypoglycaemia, hyperglycaemia, time in range
  18. patient quality of life
  19. Continuous glucose monitoring is showing the limitations of HbA1c
  20. HbA1c, mean glucose, Time in Range
  21. Ascensia Contour Next One Diabetes blood test meters
  22. My Diabetes Kit Debbie Green
  23. My Diabetes Kit Debbie Green, Accu-Chek Roche, Medtronic
  24. My Diabetes Kit Debbie Green, Accu-Chek Roche, Medtronic
  25. London Medical, London Diabetes Centre, private diabetes clinic
  26. Spirit Healthcare, Chris Barker, Leicester, Empower
  27. Spirit Healthcare, Chris Barker, Leicester, Empower
  28. Making Carbs Count chickpeas
  29. Making Carbs Count chickpeas
  30. Accu-Chek Insight insulin pump
  31. Accu-Chek Insight insulin pump
  32. Page 0032

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