I don’t think there is an A1c cut-off at which complications don’t exist. Everyone with diabetes is at a risk for developing complications. All you can do is lower your risk, and as far as I’m aware, studies have shown that, hypoglycaemia aside, the closer you can get to a “normal” A1c, the lower your risk. They have not really done studies at A1c levels below 7% since the majority of people are not able to hit that target, so it’s simply unknown whether reducing the A1c further may help or not. My guess is that it does help but at a certain point the effort needed (for many people) to maintain such tight control and the risk of hypoglycaemia outweighs any benefits to a lower A1c.
But if you can get closer to normal with no greater effort and reduced risk of lows, I’d definitely take that. I have not seen anyone mention more severe lows with the closed-loop systems. I have read about people loving Loop and loving Basal-IQ and how they are able to maintain more time in range using those systems. I have heard of people hating hte 670G because of highs since it is not aggressive enough. I really have not heard any complaints about lows, but I’d be interested in where this information has been posted.
Plus, for me it’s partly a quality of life issue. At an A1c of 6.0% I actually had fewer lows and diabetes was just far less of an issue than it is with a higher A1c and more variability and out-of-range results. Of course the trade-off, which I’m not willing to make at this time, was eating a low-carb diet. But if I could achieve those same quality-of-life benefits—sleeping through the night most nights, not having my CGM alarming constantly during the day, not having prolonged highs that wipe out my productivity for an afternoon, not having to watch the CGM constantly, having less issues with insulin sensitivity changes related to hormones or exercise or illness—I’d take them ina heartbeat. So if a closed-loop system can provide that, or even a step in that direction, even just part of the time, I’d take it.
One of the hardest things I find about diabetes is its constancy. It’s always there, day and night, day in and day out. I can never, ever, ever, ever take a break from it. And usually I don’t mind, I’ve been doing it for over 27 years and so in many ways it’s just built into everyday life. But there are times, especially when I’m overwhelmed with non-diabetes things and diabetes decides to go on a rollercoaster on top of everything else, that I feel like even just one day of not having to worry or watch or make constant decisions would be a huge help. Diabetes is always 100% me, there is no one else I can rely on or turn to for help with management. So even if a closed-loop system is something I’d only turn on during those times, even that would be helpful.