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Updated March 25, 2015.
Each year, the American Diabetes Association sets forth new Standards of Diabetes Care or position statements, which serve as clinical guidelines in the treatment of diabetes. Yearly revisions are made as a result of evidence based research and data. One of the most recent changes made was a change in self monitoring blood sugar goals.
Self monitoring blood sugars can help patients with Type 2 diabetes on insulin or oral agents evaluate their individual response to therapy and can be used as a tool for both the person and practitioner to make changes in diet, exercise, and medicines.
Studies suggest that people with diabetes who test their blood sugar may have lower HbA1c (3 month average of blood sugar). How often you test your blood sugar and what time you test your blood sugar should be individualized. The information you receive from blood sugar testing should be integrated into your treatment plan to help make assessments and changes in care.
The American Diabetes Association states that target blood sugars should be individualized based on multiple factors including:
- duration of diabetes
- age/life expectancy
- other medical issues
- known cardiovascular disease
- complications of diabetes
- hypoglycemia awareness
- individual patient considerations
What Changes Were Made and Why?
The American Diabetes Association is now suggesting that pre-meal blood sugars for nonpregnant adults with diabetes fall with the 80-130mg/dL range. This is a change from the original recommendations of 70-130mg/dL. The American Diabetes Association states that these goals are: "not designed to be applied rigidly but used as a broad construct to guide clinical decision making, both in type 1 and type 2 diabetes." The goals for peak postprandial blood sugars (1-2 hours after a meal) have remained the same at 180mg/dL.
Keeping your pre-meal and post-meal glucose values within these ranges should result in a hemoglobin A1C of 7% or less. Studies have shown that people with diabetes who reach a target A1C of 7% or less are at lower risk of microvascular and macrovascular complications. The changes to pre-meal blood sugars were made because of studies which suggested that actual average glucose levels associated with A1C targets were higher than older study targets. The ADA believes these findings support a more relaxed pre-meal target of 80-130mg/dL without effecting overall A1C.
It is important to note that the American Diabetes Association isn't the only organization that sets clinical guidelines or standards of care in diabetes management and treatment. In fact, The American Association of Clinical Endocrinologists (AACE) also has guidelines which aim for tighter blood sugar control. Your certified diabetes educator, endocrinologist or primary care physician may use these goals instead if they feel they are suitable. For example, some endocrinologists use AACE goals for young, healthy adults with Type 2 diabetes or those women with diabetes that would like to conceive a child. AACE guidelines recommend:
- Fasting plasma glucose of: <110mg/dL
- 2 hours post prandial glucose of: <140mg/dL
- Target A1c of 6.5% or less
*These recommendations are also to be individualized based on the aforementioned factors.
When Else Would Targets be Different?
Hemoglobin A1C and blood sugar targets are different for children, adolescents, women with gestational diabetes, newly diagnosed patients who are healthy with long life expectancy, and those with shorter life expectancy and advanced complications or comorbidities. For example, elderly patients with a shorter life expectancy and increased risk of hypoglycemia would benefit from reaching a target A1C of 8% or less. Most intensive treatment resulting in lower A1C may prevent cardiovascular risk factors for healthy, younger adults who've just been diagnosed with diabetes. The bottom line is, while targets are set and clinical guidelines are suggested, personal targets should be individualized. Discuss your blood sugar targets with your health care team today.
Resources:
American Diabetes Association. Standards of Medical Care in Diabetes – 2015. Diabetes Care. 2015 Jan; 38 (Suppl 1): S1-90.
AACE Diabetes Care Plan Guidelines, Endocrin Pract. 2011;17 (Suppl 2): p8.