Why Is the Blood Glucose Control of Type 1 Diabetics in England and Wales So Poor?

It is first necessary to establish the level of blood glucose control of Type 1 diabetics in England and Wales. From the National Diabetes Audit 2010-2011 (Updated 28.09/2012):

Percentage of registered Type 1 patients in England

HbA1c > 6.5%  (48 mmol/mol) = 93.1%

HbA1c > 7.5%  (58 mmol/mol) = 71.7%

HbA1c > 10.0% (86 mmol/mol) = 17.5%

Percentage of registered Type 1 patients in Wales

HbA1c >  6.5%  (48 mmol/mol) = 94.9%

HbA1c > 7.5%  (58 mmol/mol) = 75.3%

HbA1c > 10.0% (86 mmol/mol) = 20.1%

The question of why the blood glucose control of type 1 diabetics in England and Wales is so poor cannot of course be answered in a definitive manner. However, it will be shown that the eating patterns of the type 1 diabetics must be a significant factor/

The DAFNE (Dose Adjustment For Normal Eating [my italics]) structured education course is suggested for the management of type 1 diabetes. The question arises “what blood glucose levels could be achieved for type 1 diabetics under ‘normal’ eating?” Two studies of DAFNE courses in the UK give an indication.

http://care.diabetesjournals.org/content/early/2012/05/20/dc11-1579.abstract

Over a 1 year period average HbA_1c fell from 8.51% to 8.24%

http://www.ncbi.nlm.nih.gov/pubmed/22132868

Over a 7 year period average HbA1c fell from 8.6% to 8.3%

So with the best educational provision currently available (with best practise for carb counting, carb/insulin ratios, etc.) and with normal eating over a 7 year period a reduction in HbA1c of 0.3% to an average of 8.3% was achieved. The results of accepting out of control HbA1c is reported in the National Diabetes Audit 2011 – 2012 Report 2:

http://www.hscic.gov.uk/catalogue/PUB12738/nati-diab-audi-11-12-mort-comp-rep.pdf

We conclude that the reason why blood glucose control of Type 1 diabetics in England and Wales is so poor is that that normal eating is not a lifestyle that is ‘user friendly’ for diabetics. Of course, there are Type 1 diabetics forum members achieving HbA1c < 6.5%. Examples include: Fergus, Dillinger, Pneu and others. What is the factor that links Fergus, Dillinger and Pneu?

I couldn’t resist finishing the post with a genuine photograph [from a post by Eddie] of what DAFNE participants get to eat and take home from the course.

 Ya couldn't make it up! [quote from the same post by Eddie].