6. Glycemic Targets: Standards of Medical Care in Diabetes—2019

Abstract

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. ASSESSMENT OF GLYCEMIC CONTROL Glycemic management is primarily assessed with the A1C test, which was the measure studied in clinical trials demonstrating the benefits of improved glycemic control. Patient self-monitoring of blood glucose (SMBG) may help with self-management and medication adjustment, particularly in individuals taking insulin. Continuous glucose monitoring (CGM) also has an important role in assessing the effectiveness and safety of treatment in many patients with type 1 diabetes, and limited data suggest it may also be helpful in selected patients with type 2 diabetes, such as those on intensive insulin regimens (1). A1C Testing Recommendations 6.1 Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). E 6.2 Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. E 6.3 Point-of-care testing for A1C provides the opportunity for more timely treatment changes. E

The sweet spot: fasting glucose, cardiovascular disease, and mortality in older adults with diabetes: a nationwide population-based study

“…This condition can consequently trigger cardiac arrhythmia, vasoconstriction, thrombogenicity, vascular inflammation, and vasoconstriction, leading to cardiovascular event or mortality [23]. Although the optimal range for fasting blood glucose associated with lower risk, as suggested in our study (95-124 mg/dL), might be narrower than that suggested by the global guideline, it overlaps with the general target range of fasting glucose (90-130 mg/dL) recommended by a global diabetes guideline for older adults with diabetes [24].…”

Estimation of effects of nationwide lockdown for containing coronavirus infection on worsening of glycosylated haemoglobin and increase in diabetes-related complications: A simulation model using multivariate regression analysis

“…Achieving and maintaining good glycemic control (defined as an HBA1c <7.0%) is one of the primary requirements to reduce diabetes related complications. [13,14]. It is also important to take into consideration that while the whole world is struggling to contain this deadly viral illness, focus on the co-morbidities facilitating the viral-related morbidities and mortality cannot be compromised.…”

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“…Diabetes is said to be uncontrolled when the blood glucose levels/glycosylated hemoglobin levels are not within the targets specified for that particular patient at a given time. HbA1c <7.0%, pre-prandial capillary plasma glucose of 80-130 mg/dl and peak postprandial capillary plasma glucose <180 mg/dl are considered as the glycemic targets for non-pregnant adults with diabetes by ADA recommendations [6]. Despite of the increasing therapeutic options for management of diabetes, inability to achieve good glycemic control remains the greatest challenge for the medical fraternity.…”