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Wednesday 28 March 2012

NICE Guidelines Versus Near Normal HbA1c

On diabetic forums there is often discussion of the NICE guidelines for HbA1c versus attempting to keep to "near normal" levels. The most heated comments come from those defending the NICE levels. It may a coincidence but these defenders also seem to be the most fervent anti-lowcarbers. To remind ourselves what is at stake, the following is from a previous post.

People with diabetes have about twice the risk of developing a range of CVD, compared with those without diabetes [Ref 1].

People with Type 2 diabetes have a two-fold increased risk of stroke within the first five years of diagnosis compared with the general population [Ref 2 & 3].

People with diabetes are 10 to 20 times more likely to go blind than people without diabetes [Ref 4].

People with diabetes are twice as likely to suffer from cataracts or glaucoma as the general population [Ref 5].

Worldwide, the rate of leg amputations in people with diabetes is over 15 times higher than in people without diabetes [Ref 6].

The prevalence of depression is approximately twice as high in people with diabetes as it is in the general population [Ref 7].

Chronic painful neuropathy is estimated to affect about one in six (16.2 per cent of) people with diabetes, compared with one in 20 (4.9 per cent) in the age and sex matched control group [Ref 8].

There are further statistics on other complications, but none that I can easily find that show such an easy comparison between diabetics and non-diabetics and provide such strong incentives for keeping blood glucose levels as near as possible to “normal” levels.

For diabetic parents two questions to be answered
1. Do I selfishly satisfy my food pleasures against the known risks for my family?
2. Are those carbs worth it?

References
1. Emerging Risk Factors Collaboration (2010). Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 375 (9733); 2215–2222
2. Emerging Risk Factors Collaboration (2010). Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 375 (9733); 2215–2222 
3. Jeerakathil T, Johnson JA, Simpson SH et al (2007). Short-term risk for stroke is doubled in persons with newly treated Type 2 diabetes compared with persons without diabetes: a population based cohort study. Stroke 38 (6); 1739–1743
4. Hamilton AMP, Ulbig MW, Polkinghorne P (1996). Management of diabetic retinopathy, London: BMJ Publishing
5. Ederer F & Taylor HR (1981). Senile lens changes and diabetes in two population studies. American Journal of Ophthalmology, 91, 3, 381–385
6. Boulton AJM. Foot problems in patients with diabetes, in Holt RIG, Cockram CS, Flyvbjerg A et al (ed.) Textbook of diabetes, 4th edition. Oxford: Wiley-Blackwell
7. Katon W, von Korff M, Ciechanowski P et al (2004). Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care 27; 914–920
8. Daousi C et al (2004). Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabetic Medicine 21 (9); 976–982

9 comments:

Lowcarb team member said...

Quote from Sid on Nice guidelines;

"I quote the same figures that NICE do I quote the same figures that Daisy does in her welcome to new members who are confused and I add the same caveat that many will want better/lower numbers - But I use the same figures I dont try to confuse people by using a totally different set of numbers."

http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=15&t=28006&start=15#p259241

This is Daisy's caveat;

"However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets"

There will be many diabetics that visit the DCUK forum who don’t become members but will take in this information for the newly diagnosed. Sid adds the same caveat as Daisy, this give the impression that a 2 hour post prandial of 8.5 mmol/L is a safe level to be at, just think what the 1 hour PP could be, got to be into double numbers that is "not" a safe place for a diabetic to be. The words “able to or may wish to” are totally inappropriate.

Graham

Anonymous said...

Is Daisy another Ken stooge? Cut and paste and the three word game.

Anonymous said...

It is more the fact that Graham still cannot get over the fact that he was banned from DCUK. Why wouldn't they want a bad tempered duck on there who liked to deride others?

Felix said...

Even though he is safe from his tormentors on DUK, hidden benath the fat ex-coppers copious bingo wings at Diabetes-ABC, Sid still manages to make himself look like an idiot:
http://www.diabetesabc-uk.com/dukan-diet-dangerous-t111.html

Lowcarb team member said...

"It is more the fact that Graham still cannot get over the fact that he was banned from DCUK. Why wouldn't they want a bad tempered duck on there who liked to deride others?"

Are you so naive to think we would not have a presence on the largest diabetes forum in the UK. The duck may have gone, but Graham never left. Not all our forum names, are as obvious as lowcarb man and Wallycorkers ghost.

Isn’t it great to see all the good lowcarb news on the forum. Hour after hour, day after day, lowcarb is winning hands down. Only a few lowcarb antis left, and they look more ridiculous each time they post. I’m loving it !!

Eddie

Anonymous said...

Depends what you mean by low carbing Eddie. There are plenty there that describe themselves as low carbers but are they? I always thought you defined it as 50 or under and not 100+.

Lowcarb team member said...

Sid has some competition. Appetite suppressants thread at diabetes.co.uk forum.

Question.

“Does anyone know if there is anything that can be prescribed by a GP that will suppress my appetite, I'm hungry all the time but still stick to just 3 meals a day without snacking”

Answer from phoenix

“Baby new potatoes. They are lower GI and because they are less dense you appear to get a lot more for the same weight.150g of them is quite a lot and about 25g carb. Normally I'd eat them plain boiled/steamed”

I think the idea is, if one gets jammed in your throat, your appetite is suppressed.

Eddie

Anonymous said...

Spuds as appetite suppressants only an idiot could come up with that, protein or fats would be far more effective and have much less impact on blood sugar levels.

Geordie

Lowcarb team member said...

"It is more the fact that Graham still cannot get over the fact that he was banned from DCUK. Why wouldn't they want a bad tempered duck on there who liked to deride others?"

For your information sunshine the "fact" is I was not banned but was under a temporary suspension pending review and if I go to the login page that is still the case today. It was my decision not to appeal no point while kenny was still a mod getting up to his usual tricks.

Bad tempered I don't think so, I was up against the clique + Kenny who continually "derided" me. I always kept my cool despite all the vitriol thrown at me, don't forget I was not suspended for anything I said on the DCUK forum but for a trivial comment made on the Lowcarb diabetes forum, picked up by the "silver fox" (one of kennys many pseudonym's) and the the cherub.

Graham