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Friday, 21 March 2014

Dillinger sums up the pitiful achievements of the NHS and DAFNE for type one diabetics.

"Firstly, here is a summary of the DCCT/EDIC study (the DCCT bit is the short term bit and the EDIC is the follow up)

From that summary it says; “the DCCT (1983-93, mean follow-up of 6.5 years) demonstrated the beneficial effects of intensive treatment (IT), aimed at achieving glycemic levels as close to the non-diabetic range as safely possible, compared with conventional treatment (CT) on retinopathy, nephropathy, and neuropathy.”

The key thing here is close to the ‘non-diabetic range’ which in DCCT speak means below 6.0% in old HbA1c money (correct me if that’s wrong).

“Intensive treatment” meant multiple daily injections of short acting insulin with a long acting background dose; the basal/bolus we are all familiar with, there would have also been advice and support on carbohydrate counting. Note that both groups were on a diet of about 240 carbohydrates a day.

As has been stated the general reduction in HbA1c for intensive treatment didn’t get anywhere near 6.0% HbA1cs for any length of time; in fact only the very first HbA1c approached that.

The CT group maintained an average HbA1c of about 9.0% (similar to their baseline value) throughout the 3-9 (mean 6.5) years of follow-up. Those in the IT group lowered their HbA1c to about 7.0% and maintained this for the duration of the study.

However, even with those pretty poor results marked improvements in the array of diabetic complications were found; for instance the IT group reduced the adjusted mean risk for the development of retinopathy by 76 percent, as compared with CT group.

So, that is why the basal/bolus regime is pushed as a good idea for Type 1 diabetics and why the ‘support’ of the DAFNE course is given to try and replicate the support that the IT group received.

The questions then are; is a basal/bolus regime with DAFNE achieving a reduction in HbA1c?

Well, possibly; about 80% of Type 1’s are getting below 10% but are they getting anywhere near the target level normal HbA1c?

From the much discussed National Diabetic Audit for 2010/11 see page 21 for Type 1’s in England (sorry other Northern Ireland, Scotland and Wales):

So, that’s a pretty emphatic ‘no’; frustratingly they don’t use 7.0% HbaA1c to make it easy to compare to the DCCT, but they do have figures for a 7.5% HbA1c – with only 28.3% of Type 1’s getting that level. And below 6.5 the pitiful 6.9% of people – those at 6.0% or below is not clear but it’s going to be small.

How by any stretch of the imagination can that be seen as a success for DAFNE and/or the conventional approach to managing diabetes. If you produced those sorts of below target rates in the industry I’m in you would last approximately 3 months before being fired.

But that’s not all; because notwithstanding the failure to meet the pretty bad levels achieved in the DCCT of 7.0% the target of the DCCT, as I’ve said, was 6.0% - because that was felt to be the higher end of non-diabetic HbA1cs and therefore possibly achievable.

If you compare the DCCT to my own in depth ‘study’ on here:

You will see that 100% of Type 1’s got below 6.9% (the IT DCCT result) and 54% got lower than 6.1% - the described target of the DCCT. How did they do that? Was it DAFNE? Was it divine intervention? Well, we all know don’t we? It was by following a low-carb diet. Not a single low-carbing Type 1 on here has stated they have an HbA1c above 6.9% - even me with my recent blip is half a percentage point below the best that the DCCT achieved.

So, DAFNE is all well and good if like Sam says a target HbA1c of about 7.0% is what you want, but if you want to get off the complications train there is only 1 alternative…"

Nicked without Dillinger's permission from the flog. The $64,000 question, why do the carboholics believe these abysmal stats represent safe diabetic control and progress ?



Anonymous said...

Permission granted!

I think perhaps the medical profession sees the DCCT and the IT group's average blood sugar levels and says 'good enough' because they know that it's bloody difficult to get lower than that (if you are on 240 grams of carb a day).

They don't/won't/can't see that the target of the DCCT can be achieved much more easily if you are on 100 grams or 50 grams or 30 a day.

This view that you can't reduce carbs because that means eating fat is becoming increasingly stupid; as we see the 'saturated fat is evil' stance is just melting away. So, again why can't we eat low carb high fat???



Lowcarb team member said...

Thanks Dillinger

Why is it the forum members who have suffered from diabetic complications want others to go the same way ?

Over the years they have all reported serious problems on the flog and other places. Why are they so jealous of people who can hold non diabetic numbers with nil or minimal meds ?


Anonymous said...

The vast majority of diabetes, whatever type, do not socialise on forums with other diabetics and many have no intention of changing their habits. They like food and nobody or nothing, even the threat of complications, will make them change.