Good Enough May Be Good Enough

A recent article in The BMJ raised interesting questions around what the goal for blood sugar treatment should be. There have been different views (and different data) as to whether people with type 1 diabetes should have a goal of “normal” blood sugars, or simply to aim for a “pretty low” target HbA1c.
There are a few takeaways from the study: First, the most benefit in terms of long-term health is likely driven by reducing high HbA1c, rather than driving HbA1c as low as possible. Second, it really emphasized the point (again) that low HbA1cs in general come with an increased risk of hypoglycemia. Third, good enough may, in fact, be good enough.
There are a few other take-aways. In the era of CGM’s, looking at additional metrics, such as time-in-range, coefficient of variation, and average BG has a lot of value beyond HbA1c. Next, closed loop (and semi-closed loop) systems, such as 670G, Loop and (soon) Control-IQ, should really help with this, and also help with lowering the frequency of hypoglycemia.
Lastly, a note of caution: while this was a large, well done study, it is only one data point in an emerging literature as to what the “right” targets are, and that the number to aim at really should be a conversation with your doctor that takes into account a lot of things, including who you are, where you are with your diabetes There is probably not one “right” number for everyone. Hopefully, however, this will allay some of the anxiety (particularly parents) feel about needing to drive HbA1c as low as possible.
The full study can be found here.

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