“HbA1c is the currency of diabetes,” says Dr Kevin Moore, a consultant diabetologist based in Dublin and Kildare. The HbA1c blood test reflects blood sugar control over the last two to three months and is the main predictor of complications. 

Dr Moore’s job is to help patients tread the line between keeping the HbA1c low enough to avoid complications, but not so low as to cause hypoglycaemia (low blood sugar). We know that a relatively small drop in HbA1c is associated with a greatly reduced risk of complications. 

 

Patients can lose interest in consistent diabetic control

 

The ease of checking with newer diabetes technologies can make a huge difference.

There is a common pattern of an initial surge in interest and enthusiasm for keeping diabetes controlled, explains Dr Moore. His concern however is that diabetes is a “long-term game and if you don’t respect it, it’ll cause you a lot of trouble”. 

As time goes by, enthusiasm for good control can lessen and he stresses the importance of diabetic control, even when patients say they ‘feel fine’. His interest is not just how the patient feels now, but how they will feel in years or decades to come if poor control has caused complications. 

Complications related to diabetes include, blindness, kidney failure, nerve damage and an increased risk of heart attacks and strokes. Some patients with diabetes will be diagnosed in childhood, so poor control at a young age can set them on a path to complications by the time they reach their 20s or 30s.

 

Patients must be educated to make good decisions

 

Dr Moore has been involved in writing the new Irish guidelines for type 1 diabetes. The guidelines emphasise the importance of education. Patients with diabetes must self-manage their condition; they have to make many decisions every day that directly affect their diabetes. These patients need the knowledge to be able to make the right decisions, day in, day out.

The guidelines recommend that all patients should attend a structured education course within 12 months of diagnosis of type 1 diabetes . The courses are usually run over three to five days and they help to empower the patient to self-manage their diabetes on a day-to-day basis, as well as continuing a regular dialogue with their diabetes team. Dr Moore stresses the importance of patients attending this course, as there is evidence that this education has a significant effect on HbA1c and quality of life. 

 

Glucose test results downloaded to an app almost instantly

 

Technology is creeping into all areas of our life and diabetes is no different. New monitors allow patients to test their blood glucose more frequently; results are downloadable and can be analysed by the patient and by their diabetes team. Dr Moore explains how this means that some patients are now checking their sugar 15-30 times a day and are able to better understand the trends in rising or falling sugars. When he sees the patient, he can download a myriad of data which helps him to analyse and improve diabetic control. 

As with anything though, the technology only works if you use it. A patient who only tests their blood glucose once or twice a day won’t really benefit. In some cases, the ease of checking with newer diabetes technologies can make a huge difference. Patients still need to see their diabetologist usually twice a year. Adolescent and young adult patients should be seen three to four times a year as they often need more support. 

All patients with type 1 diabetes should have phone or email access to their team in between appointments and will of course also see their own GP for other medical issues, which may or may not be related to their diabetes.  

Type 1 diabetes is an incredibly challenging condition to live with, but education and technology are helping. Patients who work with their diabetes team and maintain good blood glucose control should expect to avoid significant complications of diabetes.

 

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