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Hypos and HbA1c: time to make the connection

When was the last time you had a hypo? No one wants to have them, but managing glucose levels and insulin treatment can be infuriatingly unpredictable. Try as you might to avoid hypos, diabetes from day to day is often a balancing act between aiming to keep glucose levels within target range, and going too low.

Of course, the main treatment goal of diabetes is controlling your blood glucose levels as measured by the long-term measure, HbA1c. But in recent years research has shown that focusing only on a low HbA1c may have unintended consequences.

Published in mid-2008, the ACCORD trial had to be stopped early when it found people with type 2 diabetes who achieved a tightly controlled HbA1c of 6.4% were more likely to die prematurely of any cause than those whose HbA1c was 7.5%.1 This was in contrast to earlier, well-established studies, which showed the lower the HbA1c, the greater the protection against diabetes complications such as kidney disease, eye disease, heart attack and stroke.2,3

Unexpected outcomes need a new approach

‘This was unexpected and needs an explanation,’ says Dr Ramzi Ajjan, Consultant Physician and Associate Professor of Diabetes and Endocrinology at Leeds Teaching Hospitals NHS.

‘The most plausible explanation for the higher mortality in ACCORD is hypoglycaemia – that the treatment target was too low, that glucose lowering was too rapid, or that the combination of treatments led to hypoglycaemia.’

‘The emerging evidence shows that avoidance of hypoglycaemia must also be a part of the structured management approach.’

Based on this evidence, we want to tell you all about The Triangle of Diabetes Care, an exciting new clinical approach that sets not one but three treatment goals:

• Improving HbA1c

• Reducing hypos

• Avoiding glucose variability (swings between low and high blood glucose)

The Triangle of Diabetes Care is designed to help you see the bigger picture of how you manage your diabetes – a holistic approach that looks ‘under the bonnet’ of the HbA1c, to find out how to prevent hypos and swings in blood glucose levels as far as possible.

This makes day-to-day management easier, and can also help you feel you’re taking positive steps towards your long-term health and wellbeing.

In previous articles we’ve looked at The Triangle of Diabetes Care and the first goal, improving your HbA1c, in more detail. In a future article we’ll also cover the third goal, limiting glucose variability.

Are you wondering how The Triangle of Diabetes Care translates into practical tips that you can use to improve your diabetes management, and how your FreeStyle blood glucose meter can help? Head over to the FreeStyle Progress section of the website and sign up for our new education programme to find out more.


1.The Action to Control Cardiovascular Risk in Diabetes Study Group: Effects of intensive glucose lowering in type 2 diabetes. New England Journal of Medicine 2008; 358: 2545-2559

2. DCCT: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group New England Journal of Medicine 1993; 329: 977-986

3. Stratton MI et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. British Medical Journal 2000; 321: 405-412


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Modal libre bg * Scanning the sensor to obtain glucose values does not require lancets ×
*1. Scanning the sensor to obtain glucose values does not require lancets 2. A finger prick test using a blood glucose meter is required during times of rapidly changing glucose levels when interstitial fluid glucose levels may not accurately reflect blood glucose levels, or if hypoglycemia or impending hypoglycemia is reported but the symptoms do not match the system readings. ×

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