LIVINGLIVING
He continued, "Using blood glucose
numbers or improved glycaemic control
as outcome measures is too limited.
Patient quality of life can be a better
predictor of diabetes control than other
measures. For example, patients can
provide insights that doctors running
trials, for example, can often miss. Early
and continuous patient feedback is crucial
for us to develop and employ the most
effective strategies that can improve QOL
and improved blood glucose control.
The introduction of a continuous glucose
monitor might lead in the short term
to improvements in glycaemic control.
However, the initial data overload can be
very distressing for patients, so changes in
quality of life might not become apparent
until far later in comparison to changes in
blood glucose levels. We must consider
patient experience feedback and quality
of life data to be as important as HbA1c
outcomes."
A wider range of allowed parameters
has the scope to improve healthcare.
In a report, "Shift from target range to
proportion in range" published in Diabetic
Medicine, a publication from Diabetes UK,
authored by by doctors Amiel, Choudhary
and Sivasubramaniyam at Kings College
Hospital, in which the proportion of daily
blood test readings between 4 and 10
mmol/l in people achieving different HbA1c
levels were evaluated. They concluded
that participants achieving an HBA1c
reading less than 7.5% had 60% of blood
test readings in range (4-10 mmol/l), with
up to 30% of readings greater than 10
mmol/l. They determined that this target
of achieving 60% or more readings within
target, and being permissive with up to
30% readings above 10 mmol/l may be
a novel target for people with diabetes,
and may reduce anxiety associated with
readings out of range.
Choudhary explains, "What we hear
all the time at clinic is that diabetes is a
rollercoaster. People do all they can - eat
the same thing at the same time everyday
and still get blood glucose variations. And
clinics too are held to ransom by their own
HbA1c averages across the whole patient
base, and that can obviously include all
sorts of differences in control. Patients
feel judged by, or judge themselves, by
this number. The HbA1c measurement
has been around quite a while, but it's
continuous glucose monitoring that is
showing up the limitations of the HbA1c,
which is basically just a summary of control
over a three-month period. An HbA1c
result that is deemed to be good can
hide problems. Someone with an HbA1c
What gets measured gets
improved."
"