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 ?