In 1985-95, my endo started charting my A1C each visit. I was using NPH+Reg at that time, as an improvement over single injection Lente since 1965. So around 1985 my first A1Cs were in the 12-14 range, and got down to 9s with the “mdi” and bg testing. My doctor charted A1Cs, showing improvements, with a star when I hit 9. They didn’t want to go much lower than 8s due to fear of hypos. CGMS and newer insulins changed everything, even with the crude original sof-sensors from Medtronic, around 1995, and then Dexcom Seven (before G4).
After that, improved CGMS, lower carb, and DOC forums got me to the 5s.
Scientific research is great, and I’ll comb through this tomorrow when I’m not tired… but it’s not without its flaws. Average A1Cs of diabetics will vary tremendously based on a multitude of factors. Science deliberately disallows common sense and experience but it can’t make either invalid.
This is the second paper along with the first already posted
Interpretation
Deaths in people with diabetes in England have more than doubled during the COVID-19 epidemic.
Hyperglycaemia and obesity in both Type 1 and Type 2 diabetes were independently associated with increased
COVID-19 mortality. Risk factor control could diminishthe impact of COVID-19 in diabetes.
Science doesn’t disallow them. It just doesn’t use them to form conclusions. Hypotheses, sure—often those are a large part of how scientific queries are formed. Those then need to be tested and supported with evidence though (in ways that have the potential to disprove them, i.e., the scientific process), to be seen as anything beyond hypothetical, given the huge potential for heuristics/biases to inform common sense and anecdotal experience.
From IDS:
”This study found a definitive link between blood sugar control, as assessed by A1c, and mortality. Increased risk was found to begin at an A1c of 7.5% (58mmol/mol) and rose thereafter. The study found a non-intuitive slight increase of mortality rate for patients with “tight” control, but it was not deemed statistically significant, and even if accurate, could be due to any number of confounding factors unrelated to healthy glycemic control.”
My wife sees diabetic patients in clinic that regularly have 12-14 A1C’s, and their general practitioners think that is perfectly fine. Below 8 is rare in the clinic. She refers all these patients to endocrinologists, but few ever go. I believe it is a socio-economic divide (but I’m no scientist nor sociologist).
Granted, she doesn’t work for an endocrinologist, but I question where the scientists get their study subjects… mostly educated diabetics that would normally watch their A1C and watch for such studies? I know I get mail about such studies from my endo, and never a GP.
“The National Diabetes Audit (NDA) collates data on nearly all people with diagnosed diabetes registered with a healthcare provider in England. Individuals are included if they have a valid code for diabetes mellitus (excluding gestational diabetes) in their electronic health record.”
“The diabetes cohort study population used to investigate risk factors for COVID-19 related mortality were people with Type 1 diabetes or Type 2 diabetes who had been included in the 2018/19 NDA data collection, whose most recent General Practice was in England and who were alive on 1st January 2020.”
11.8% of type 1 diabetes patients had an A1c >10% and 16.7% of T1Ds who died from Covid-19 had an A1c >10%. HbA1c data were missing for 23% of T1Ds and 17% of T1D deaths of Covid-19.
“In England” - the US doesn’t have such tracking of diabetics, outside individual insurance for the most part.
My comment was more directed at studies in general. Here they ask questions on a website, where they publish studies they are doing, to see if you qualify to their criteria.
Hi everyone, and thanks especially to @marie for posting this. Very useful, although scary. As a T1 diabetic, we are at higher risk even than t2 diabetics ceteris paribus (all other things constant).
From my perspective, it’s best to go with the big story rather than the subtexts or complications. And for that reason this study is sobering.
Stay safe all you T1s, and be extra careful.
How much extra? About 3 x extra careful, according to the estimable folks at NHS.
I did not read the article, but I am reading the interesting posts on the thread. What I was told was that if my A1c were in a “non-diabetic” range (i.e. 5.2%) that I was not at any more risk for contracting the virus than a non diabetic. However, I don’t think that they are taking into account that we with such tight controlled BGs may also have developed or already have underlying conditions (neuropathy, heart disease, retinopathy) which may put them into a more compromised immune category, thus making them more suseptable to contraction. Just my 2 cents.
The way I am interpreting all this makes sense to me but might not for younger Type 1s…My risk of contracting Covid-19? That is something I control. You won’t see me socializing with any of the looters, no airplanes, etc together with social distancing for the duration (no hockey).
My mortality risk if I catch the virus? The paper seems to say that it sucks regardless of A1c. In my 60’s, I’ve mentally been looking at my mortality risk as if I were in my late 70’s (i.e. triple the risk of a non diabetic 63 year old). That plus the deep seated fear that my BG will be no longer be decently controlled if I end up on my back in a hospital bed with the virus, causing further medical snafus and complicating treatment/recovery.
Anyway, not to be a dark cloud but for anybody over 60 with diabetes this virus is without a doubt a high risk illness…so we should do everything we can to avoid catching it.
Right, I really wonder if this actually has a bigger impact than A1c. Particularly when you’re on a ventilator and under full anesthesia there’s no way they’re going to control your BG as tightly as you did before. Who knows what constant hyperglycemia does to your body and immune system when it’s fighting a nasty virus?