National Institute for Health and Clinical Excellence NICE

"NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health."

Clinical Excellence, what does the word Excellence mean to you, high quality, very high standard, the best, superior. My point is, the NICE guidelines are a very long way from being excellent, in fact they are almost a guarantee for long tem diabetic complications. Recently relaxing from HbA1c 6.5 to HbA1 7.5 patient outcomes will only get worse.

Look at it this way. Imagine a road where many people were being killed and injured, and after a survey you found irrefutable evidence, speed limit was the reason. The obvious answer is lower the speed limit, anyone suggesting raising the limit would be considered an imbecile. That’s how I view the raising of the NICE guidelines. It is well known that reducing HbA1c reduces complications.

For every percentage point drop in A1C blood test results (from 8.0 percent to 7.0 percent, for example), the risk of diabetic eye, nerve, and kidney disease is reduced by 40 percent. Lowering blood sugar reduces these micro vascular complications in both type 1 and type 2 diabetes. Intensive blood sugar control in people with type 1 diabetes (average A1C of 7.4%) reduces the risk of any CVD event by 42 percent and the risk of heart attack, stroke, or death from CVD by 57 percent.

Source: DCCT/EDIC, reported in December 22, 2005, issue of the New England Journal of Medicine.

Back to the word Excellence, it seems to me the average person would equate Excellence and a guide line of HbA1c 7.5 as achieving an excellent blood glucose result, unfortunately this is not the case. HbA1c 7.5 = an average blood glucose number of approximately 9, twice that of a healthy non diabetic. The target for diabetics should be set at non diabetic levels. Under the old recommendation of 6.5 the statistics were atrocious, can the people at NICE really believe the outcomes for diabetics will improve by raising the bar, not a chance in my opinion.
　

NHS Statistics for 2008 2009:

Percentage of Type 1 diabetics with HbA1c greater than 7.5 per cent = 71.4 per cent.

Percentage of Type 2 diabetics with HbA1c greater than 7.5 per cent = 33.4 per cent.

Percentage of Type 1 diabetics with HbA1c greater than 10.0 per cent = 33.6 per cent.

Percentage of Type 2 diabetics with HbA1c greater than 10.0 per cent = 14.3 per cent.

These results are very similar to those found in 2006 – 2007 and 2007 – 2008.

Eddie