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.

One thought on “Good Enough May Be Good Enough

  1. Thank you. Very helpful perspective that aligns with what I recall I learned from my experience at Camp Bearskin Meadow when I was a counselor there and on the first insulin pump commercially available in 1981, the Autosyringe pump. I recall coming away from my experience and discussions with Dr. Ellen Simpson that helped me develop the perspective that I needed to keep myself under good control with a glycohemoglobin (precursor to the HBA1c) that was close to normal but needed to live my life as a person balanced with my life as type 1 diabetic. Spending one’s life feeling controlled by the disease (chasing the lowest HBA1c possible) leads to a pretty boring person and a pretty boring life. Living as a normal person with an eye on managing one’s disease admist the ups and downs of everyday life is the approach I’ve tried to take. After 42 years T1D, I am still complication free. I remember my summer at camp and the people I got to know there with great fondness and appreciation for helping me to develop a very healthy approach to my life.

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