Survey Reveals How to Get a Great A1C

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It’s not easy having a pancreas that just can’t get the job done by itself. Studies have consistently shown that a distressingly low percentage of people with diabetes meet the official glycemic targets set by the American Diabetes Association and other similar organizations. This is the unfortunate truth among people with both Type 1 and Type 2 diabetes.

Every person with diabetes is in daily battle with chronic hyperglycemia, and some do it better than others. What techniques, habits, philosophies and circumstances ultimately make the difference?

While we all have our own theories on glycemic management, the team at Diabetes Daily wondered if they could inject some objectivity and data into a conversation that so frequently revolves around anecdotes. And so the website, harnessing a huge data set of over 17,000 survey respondents, examined the habits of those who meet and surpass glycemic targets and compared them with those who fall short.

Maria Muccioli
Maria Muccioli

Over the fall, Diabetes Daily released regular updates on the study, examining which strategies were most often used by those who had achieved healthy blood sugars. Now the website has compiled all of its results and conclusions into a single mammoth report: the Habits of a Great A1C Survey Data Report. It’s essential reading for anyone with an interest in superior glycemic management. 

We spoke with staff writer Maria Muccioli, a biology professor (with Type 1 diabetes) who acted as the principal investigator on the report.

 

What was the impetus behind the survey? 

We are so excited to utilize our Thrivable Insights panel of about 20,000 people to begin conducting data-driven journalism. Many interesting ideas were discussed, and for our first research project we chose to try to identify differences in the way people with lower A1c levels may choose to manage their diabetes. Our mission is to help people with diabetes thrive, so uncovering strategies that may help people be more successful is of utmost importance to us.

The word “habit” seems important. Can you expand on why you used that word instead of “strategy” or “technique” or something similar? 

I think when it comes to diabetes management, consistency is key. As many will likely agree, it’s really a marathon and not a sprint, when it comes to successfully managing a chronic health condition like diabetes. Strategies that work well (in diabetes management and life in general) often become incorporated as habits, I think.

 

What was the most surprising result for you? 

I have to say, overall, I think the results were consistent with what I suspected we would find. It makes sense logically that habits like regular exercise and making smart and consistent food choices are effective strategies to help with diabetes management.

One surprising finding was that among people with type 1 diabetes, varying the timing of bolus insulin was significantly more common among those with higher A1c levels. I would have thought that adjusting the dose timing based on the meal (and other factors) is a good strategy. In retrospect, it is also possible that variable bolus timing indicates haphazard bolusing patterns (e.g., forgetting to bolus). Also, among those with type 1 diabetes, although more people in the lower A1c group reported regularly pre-bolusing for meals (30% vs. 18%), this difference did not quite reach statistical significance. I was expecting to see more of a difference there, I think, as I have heard so often from many in the online community what an effective strategy pre-bolusing is!

Also, I was surprised that we did not see any significant difference in the proportion of people using half-unit insulin syringes or pens among those on multiple daily injections between the A1c groups. Another recent study indicated a benefit of using half-unit delivery devices, and it makes sense that more precise dosing would be useful, but we did not see this at all among our study population.

Finally, I was a little surprised by just how many people reported eating low-carb as well as using technology, like CGM and/or insulin pump, across all the groups! Of course, this is not a random population. The very fact that these individuals seek out online resources for diabetes management and join research efforts suggests that they may be particularly motivated about diabetes management relative to what we might find in a random sample.

 

What was the most striking divergence between the T1 and T2 communities? 

Actually, so many differences between the two A1c groups among the type 1 and type 2 population showed the same trend. One difference is what was mentioned above, about variable bolus timing. Among those with type 2 diabetes, varying bolus timing depending on the specific circumstances was slightly more common among those with lower A1c levels. Also, and this is probably not a surprise, but the percentage of people who use insulin pump and/or CGM technology was a lot lower than for those with type 2, and although insulin pump use was more common among those with lower A1cs, no such difference was observed for CGM use (in contrast with the type 1 population).

 

Any plans to follow this study up with more data-driven journalism? 

Yes, absolutely! We have many ideas in the works, including one that focuses on the insulin affordability issue. The cost of insulin has been skyrocketing in recent years, and it has been estimated that as many as 25% of patients with diabetes regularly ration their insulin. To design more effective solutions to this problem, we first need to better understand the issue, so we would like to focus on elucidating the characteristics common to those affected by high insulin prices.

Also, there is even more that could be uncovered from this initial survey effort about management habits! We collected so much data for this study, and I look forward to digging even deeper.

 

Did the results inform your own management strategy? Any personal takeaways? 

I’ve had type 1 for over 13 years now, and over time, I learned what works best for me personally. Using a CGM regularly and following a consistent, lower-carbohydrate diet approach that focuses on whole foods, along with carefully calculated insulin dosing strategies (like bolusing for protein) has been extremely effective for me to maintain minimal glycemic variability and clinically normal A1c levels. I knew I was not alone in finding these strategies effective, and the main outcomes of this work support that as well.

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