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Type 1 Diabetes A1c Goal For Adults

Boston, Usa

Boston, Usa

8/7/2015 1 ADA Type 1 Diabetes Guidelines Pediatric and Adult Patients with T1D: Glycemic Targets and more Lori Laffel MD MPH Chief, Pediatric, Adolescent & Young Adult Section Senior Investigator, Genetics and Epidemiology Section Professor of Pediatrics Boston, USA AADE New Orleans, LA Disclosures Consultant • Johnson & Johnson, Eli Lilly, Sanofi-Aventis, NovoNordisk, Bristol Myers Squibb, Menarini, Bayer Healthcare (grant support), LifeScan/Animas, Roche Diagnostics, Oshadi, Dexcom, Boehringer Ingelheim Content of lecture unrelated to above 2014 CDC June Report • Prevalence estimates of T1D in youth 0-19 and T2D in youth 10-19 in 2001 and 2009 in 5 representative US areas in the SEARCH Study • T1D prevalence: 1.48/1000 in 2001 (1/676) 1.93/1000 in 2009 (1/518) • T2D prevalence: 0.34/1000 in 2001 (1/2941) 0.46/1000 in 2009 (1/2174) • T1D increased 21.1% (95% CI, 15.6-27.0%)* • T2D increased 30.5% (95% CI, 17.3-45.1%)* * After adjustment for case ascertainment T1D in Adults • No precise estimates of T1D in adults >20 y/o • Greatest number of patients with T1D are adults: – Increasing numbers of patients diagnosed with T1D at all ages – Patients w/ childhood onset T1D survive to adulthood • Estimated that 50-75% of T1D diagnosed in childhood (25-50% diagnosed in adulthood) • LADA: latent autoimmune diabetes in adults – ~9% of adults with diabetes ages 30-70 have +GAD ab – Prolonged period of residual beta cell function (T1DX) – Additional peak age of onset of T1D in 6th to 7th decades of life • Diabetes Care. 2015 Mar;38(3):476-81. Diabetes Care. 2015 Mar;38(3):476-81. Residual C-peptide present in 1/3 persons with T1D of 3+ years duration 8/7/2015 2 • Glycemic tar Continue reading >>

Type 1 Diabetes Through The Life Span: A Position Statement Of The American Diabetes Association

Type 1 Diabetes Through The Life Span: A Position Statement Of The American Diabetes Association

Incidence and Prevalence of Type 1 Diabetes The exact number of individuals with type 1 diabetes around the world is not known, but in the U.S., there are estimated to be up to 3 million (1). Although it has long been called “juvenile diabetes” due to the more frequent and relatively straightforward diagnosis in children, the majority of individuals with type 1 diabetes are adults. Most children are referred and treated in tertiary centers, where clinical data are more readily captured. The SEARCH for Diabetes in Youth study estimated that, in 2009, 18,436 U.S. youth were newly diagnosed with type 1 diabetes (12,945 non-Hispanic white, 3,098 Hispanic, 2,070 non-Hispanic black, 276 Asian-Pacific Islander, and 47 American Indian) (2). Worldwide, ∼78,000 youth are diagnosed with type 1 diabetes annually. Incidence varies tremendously among countries: East Asians and American Indians have the lowest incidence rates (0.1–8 per 100,000/year) as compared with the Finnish who have the highest rates (>64.2 per 100,000/year) (3). In the U.S., the number of youth with type 1 diabetes was estimated to be 166,984 (4). The precise incidence of new-onset type 1 diabetes in those over 20 years of age is unknown. This may be due to the prolonged phase of onset and the subtleties in distinguishing the different types of diabetes. In one European study of adults aged 30–70 years, ∼9% tested positive for GAD antibodies (GADA) within 5 years of a diabetes diagnosis, consistent with other studies (5). Adults with type 1 diabetes often receive care in primary care settings rather than with an endocrinologist. Unlike the consolidated care seen in pediatric diabetes management, the lack of consolidated care in adults makes incidence and prevalence rates difficult to characterize, an Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Print Diagnosis Diagnostic tests include: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes. If the A1C test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as pregnancy or an uncommon form of hemoglobin (hemoglobin variant) — your doctor may use these tests: Random blood sugar test. A blood sample will be taken at a random time and may be confirmed by repeat testing. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. If you're diagnosed with diabetes, your doctor may also run blood tests to check for autoantibodies that are common in type 1 diabetes. These tests help your doctor distinguish between type 1 and type 2 diabetes when the diagnosis is uncertain. The presence of ketones — byproducts from the breakdown of fat — in your urine also suggests type 1 diab Continue reading >>

Goals Of Treatment

Goals Of Treatment

Blood sugar control means knowing a few important numbers. The ADA recommends that your glucose levels be: Before Meal 70–130 mg/dl After Meal < 180 mg/dl Goals Of Diabetes Treatment To keep the blood sugar as normal as possible without serious high or low blood sugars Normal ranges for blood sugar People who don’t have diabetes keep their blood sugars between 60 – 100 mg/dl overnight and before meals, and less than 140 mg/dl after meals. Although the ultimate goal of diabetes management is to return the blood sugar to the natural or non-diabetic level, this may be difficult without excessive low blood sugars or hypoglycemia. What are the blood sugar (glucose) targets for diabetes? The ultimate treatment goal for Type 1 diabetes is to re-create normal (non-diabetic) or NEARLY normal blood sugar levels – without causing low blood sugars. Good blood sugar control requires that you know and understand a few general numbers. The numbers measure how much glucose is in your blood at certain times of the day and represent what the American Diabetic Association believes are the best ranges to prevent complications. American Diabetes Association Recommendations A1c* < 7.0% Before Meal Glucose Level 70-130 mg/dl After Meal Glucose Level < 180 mg/dl *Hemoglobin (A1c) is a measure of your average blood glucose control over the previous 3 months. Think of the A1c as a long-term blood glucose measure that changes very gradually. For example: When you have type 1 diabetes you are treated with insulin replacement therapy. The goal is to replace the insulin in the right amount and at the right time. Sometimes, more insulin than needed is taken and this will cause hypoglycemia. To minimize this risk, many providers will recommend that individuals treated with insulin target a pre Continue reading >>

Type 2 Diabetes Glucose Management Goals

Type 2 Diabetes Glucose Management Goals

Optimal management of type 2 diabetes requires treatment of the “ABCs” of diabetes: A1C, blood pressure, and cholesterol (ie, dyslipidemia). This web page provides the rationale and targets for glucose management; AACE guidelines for blood pressure and lipid control are summarized in Management of Common Comorbidities of Diabetes. Glucose Targets Glucose goals should be established on an individual basis for each patient, based on consideration of both clinical characteristics and the patient's psycho-socioeconomic circumstances.1-3 Accordingly, AACE recommends individualized glucose targets (Table 1) that take into account the following factors1,2: Life expectancy Duration of diabetes Presence or absence of microvascular and macrovascular complications Comorbid conditions including CVD risk factors Risk for development of or consequences from severe hypoglycemia Patient's social, psychological, and economic status Table 1. AACE-Recommended Glycemic Targets for Nonpregnant Adults1,2 Parameter Treatment Goal Hemoglobin A1C Individualize on the basis of age, comorbidities, and duration of disease ≤6.5 for most Closer to normal for healthy Less stringent for “less healthy” Fasting plasma glucose (FPG) <110 mg/dL 2-hour postprandial glucose (PPG) <140 mg/dL The American Diabetes Association (ADA) also recommends individualizing glycemic targets (Table 2) based on patient-specific characteristics3: Patient attitude and expected treatment efforts Risks potentially associated with hypoglycemia as well as other adverse events Disease duration Life expectancy Important comorbidities Established vascular complications Resources and support system Table 2. ADA-Recommended Glycemic Targets for Nonpregnant Adults3 Parameter Treatment Goal Hemoglobin A1C <6.5% for patients Continue reading >>

Understanding Your A1c

Understanding Your A1c

The A1C is a blood test that helps determine if your diabetes management plan is working well. (Both Type 1 and Type 2 take this test.) It’s done every 2-3 months to find out what your average blood sugar has been. (You may also hear this test called glycosylated hemoglobin, glycohemoglobin, hemoglobin A1c, and HbA1c.) A1c is the most common name for it though. How the test works Essentially, the test can tell how much sugar is in the blood stream by looking for proteins (hemoglobins). When glucose (sugar) enters the blood, it binds to the protein in the red blood cells. This binding creates “glycated hemoglobin”. The more sugar in the blood, the more glycated hemoglobin. It’s important to test your blood sugar levels (BGLs) throughout the day; however, an A1C test gives you a bigger picture with a long-term average of those blood sugar levels. What do these numbers mean? The A1c is an average of what your blood sugar levels have been over the 3-month period. In general, the higher your A1C number, the higher your likelihood of diabetes complications. (You don’t want a high A1C; it means there is too much sugar in your blood and your body isn’t absorbing it.) A1C number 4.6 – 6.0 Normal (does not have diabetes) 5.7 – 6.4 Pre-diabetes (warning that someone may develop Type 2 or have the beginning onset of Type 1) 6.7+ Diabetes (someone diagnosed with diabetes) <7.0 – 7.5 Target range (for adults diagnosed with diabetes – children diagnosed with diabetes) This target range varies between individuals, some people naturally run a little higher, some lower. It is important to note that especially in children a higher A1C (of 7.5) is recommended. The A1C number will help you and your doctor determine though if your diabetes management plan is working well. Continue reading >>

Ada: Teenagers With Type 1 Diabetes Not Even Close To Meeting Goals

Ada: Teenagers With Type 1 Diabetes Not Even Close To Meeting Goals

One in 5 kids with diabetes has an A1C above 10%…. According to results of the TEENs Registry Study, presented at the American Diabetes Association 2014 Scientific Sessions, 75 percent of young people living with type 1 diabetes are not meeting the recommended glycemic goals. The TEENs study, funded by Sanofi, was one of the largest studies to ever assess type 1 diabetes management and the factors that affect it. Commenting on the study was Dr. Lori M.B. Laffel, chief of the pediatric, adolescent and young adult section of the Joslin Diabetes Center and associate professor of pediatrics at Harvard Medical School in Boston, Massachusetts. Dr. Laffel said in her presentation of the results, "Despite modern advances in insulin replacement, the majority of young patients still fail to achieve recommended glycemic targets. In addition many continue to experience acute complications including both hypoglycemia and diabetic ketoacidosis." The data was collected from 5,960 participants between the ages of 8 and 25 seen at 219 diabetes centers in 20 developing and developed countries including Europe, the United States, Latin America, the Middle East, Africa and India. The patients had a mean age of 15 and a mean disease duration of 7 years. 75% of participants were white and between 26% and 29% were clinically overweight or obese. Average A1C levels were 8.3% for the 1724 children ranging in age from 8 to 12, 8.6% for the 2854 participants between the ages of 13 and 18 and 8.4% for the 1382 young adults aged 19 to 25. Overall 72% of participants were not meeting recommended A1C targets; less than 7.5% for those 18 or younger and less than 7% for diabetics between the ages of 19 and 25. Rates of DKA and severe hypoglycemia were higher among the young adults than either the tee Continue reading >>

Type 1 Diabetes Stroke Risk And What A1c Levels To Aim For

Type 1 Diabetes Stroke Risk And What A1c Levels To Aim For

A study finds that those with type 1 diabetes have a higher risk for ischemic and hemorrhagic stroke, particularly in those with poor blood sugar management. Researchers in Sweden set out to estimate the elevated risk of stroke in relation to blood sugar management in patients with type 1 diabetes. The prospective, matched cohort study identified 33,453 patients with type 1 diabetes age 18 or older who were registered in the Swedish National Diabetes Register from 1998-2011 plus five control subjects per case from the general population which were matched for age, gender, and county of residence. Risk for any kind of stroke including ischemic and hemorrhagic stroke were estimated by Cox hazard regression. Does Poor Diabetes Management Increase Risk of Stroke in Type 1 Patients? Of the 33,453 patients with type 1 diabetes (mean age 35 and mean duration of diabetes 20 years), 762 were diagnosed with stroke compared with 1122 of 159,924 control subjects.The risk for ischemic and hemorrhagic stroke rose with A1c levels. Risk for ischemic stroke increased significantly with A1c levels at or above 6.9% (≤52 mmol mol-1). Risk for both ischemic and hemorrhagic stroke also increased significantly in A1c levels at or above 9.7% (≥83 mmol mol-1).Researchers in their study abstract concluded that the risk for ischemic and hemorrhagic stroke rose alongside poorer blood sugar management. How Low Should A1c Levels Be in Patients with Type 1 Diabetes? While it varies depending on personal circumstances, the American Diabetes Association recommends that A1c levels in people with type 1 diabetes be below 7%. The Association’s magazine Diabetes Forecast states in an article that a higher or lower goal may be best for the individual. “For example, an older adult with a limited life Continue reading >>

Ada Type 1 Diabetes Position Statement Changes A1c Recommendations For Pediatric Patients

Ada Type 1 Diabetes Position Statement Changes A1c Recommendations For Pediatric Patients

News Release BOSTON – (July 18, 2014) – The American Diabetes Association released a position statement outlining care protocols for persons with type 1 diabetes. The guidelines were officially released at the 2014 ADA Annual Conference in San Francisco this past June. The position statement covers care recommendations for all age ranges, from early childhood to adulthood and into the geriatric years. Lori Laffel, M.D., M.P.H., Chief of the Pediatric, Adolescent and Young Adult Programs and Senior Investigator in the Section on Genetics and Epidemiology at Joslin. This position statement arose from the type 1 Diabetes Sourcebook which was produced by the American Diabetes Association and the JDRF, and received funding from the Helmsley Charitable Trust. Over half a dozen authors from the Joslin Diabetes Center contributed to the Sourcebook and the position statement. Lori Laffel, M.D., M.P.H., Chief of the Pediatric, Adolescent and Young Adult Programs and Senior Investigator in the Section on Genetics and Epidemiology, was a lead author on guidelines. The new position statement is exclusively focused on those with type 1 diabetes rather than providing care recommendations for people with diabetes in general. “Previously, guidelines for the care of persons with diabetes didn’t necessarily distinguish between patients with type 1 and type 2 diabetes,” says Dr. Laffel. She says that the statement’s streamlined presentation should make for an easier read for busy care providers. “Often the guidelines that come out every January from the Diabetes Association are very long. They compile an entire journal,” says Dr. Laffel. “This particular guideline can be digested in a brief reading.” One of the biggest changes in care recommendations relates to A1C leve Continue reading >>

Your A1c Levels – What Goal To Shoot For?

Your A1c Levels – What Goal To Shoot For?

Measuring Your A1C An A1C test gives you and your provider insight into all of your blood glucose ups and downs over the past two or three months. It’s like the 24/7 video of your blood sugar levels. Observing your A1C results and your blood glucose (also known as blood sugar) results together over time are two of the key tools you and your health care provider can use to monitor your progress and revise your therapy as needed over the years. Recent research is changing the way health professionals look at A1C levels. Instead of setting tight controls across the board, a healthy A1C level is now a moving target that depends on the patient. In the past, an A1C of 7 percent was considered a healthy goal for everyone. Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America in Tarzana, California, says experts now recommend taking a patient-centered approach to managing A1C levels, which means evaluating goals based on individual diabetes management needs and personal and lifestyle preferences. Current ADA Goals The 2015 American Diabetes Association (ADA) Standards of Medical Care in Diabetes advise the following A1C levels: • 6.5 percent or less: This is a more stringent goal. Health care providers might suggest this for people who can achieve this goal without experiencing a lot of hypoglycemia episodes or other negative effects of having lower blood glucose levels. This may be people who have not had diabetes for many years (short duration); people with type 2 diabetes using lifestyle changes and/or a glucose-lowering medication that doesn’t cause hypoglycemia; younger adults with many years to live healthfully; and people with no significant heart and blood vessel disease. • 7 percent: This is a reasonable A1C goal for many adults with d Continue reading >>

Study Reveals Poor Disease Control Among Adolescents And Young Adults With Type 1 Diabetes

Study Reveals Poor Disease Control Among Adolescents And Young Adults With Type 1 Diabetes

T1D Exchange Clinic Registry data find a stagnant situation as little has changed in 25 years; underscores need for new technologies to help teens manage their disease BOSTON, May 22, 2015 – In a sweeping analysis assessing the current state of diabetes treatment in the U.S., T1D Exchange researchers conclude that there remains considerable room for improving treatment outcomes in type 1 diabetes across all age groups, but especially for adolescents and young adults. The analysis provides the most up-to-date picture of diabetes treatment, underscoring the need to address barriers to care and implement new therapies and technologies that can help type 1 patients achieve optimal metabolic control. The findings, published today in a special issue of Diabetes Care, come from data collected by the T1D Exchange Clinic Registry. Researchers from the Exchange evaluated data from more than 16,000 patients ages two to 95. Data were collected twice: between September 2010 to August 2012 and again, from September 2013 to December 2014. A key area of study was glycemic control across the age spectrum, determined by examining Hemoglobin A1c (HbA1c) levels, a standard test of average blood sugar levels over two to three months. According to the American Diabetes Association, the recommended target A1c level is less than 7 percent for adults with type 1 diabetes and less than 7.5 percent for youth under the age of 19. Researchers found that while 8.4 percent remains the average A1c level across the Registry, A1c levels are notably worse among 13 to 25-year olds. In fact, A1c levels for 13 to 17-year olds have barely changed since the initial Diabetes Control and Complications Trial (DCCT) results published in 1992. Specifically: Adolescents in the Registry averaged a 9.0 percent A1c Continue reading >>

A1c Goals For Children & Teens With Type 1 Diabetes: Helpful Or Harmful?

A1c Goals For Children & Teens With Type 1 Diabetes: Helpful Or Harmful?

A retrospective study of HbA1c measurements of children, adolescents and young adults with T1DM was published this week, Trajectories of HbA1c Levels in Children and Youth with Type 1 Diabetes. The children were followed in Juvenile Diabetes Clinic, Maccabi Health Care Services, Israel, from January 1995 to September 2010. Consecutive HbA1c measurements of 349 patients, aged 2 to 30 years with T1DM were obtained from 1995 through 2010. The study sample comprised 4815 measurements of HbA1c from 287 patients. The study data showed that many children, especially adolescents with T1DM, do not meet the set targets. Not meeting the HbA1c targets can lead to early complications and even, early death. The study found that 75% of A1c measurements in children younger than 6-years were within the recommendations, although the set target for this population is less stringent than all the others. At adolescence ADA recommendations are more rigorous aiming to lower HbA1c levels, but the study data showed that during this period HbA1c levels increase to peak levels, therefore 75% of adolescents did not meet targets, reflecting the challenge in achieving glycemic control during pubertal years. After age 18 years of age the distribution curves show improvement in all percentiles. Mean levels of HbA1c from 117 subjects decreased from age 18 to 24 years [22]. However, since the target recommended HbA1c after age 18 is 7% (<53 mmol/mol), only 25% of the measurements were within the target. In terms of gender, comparison between the female and male HbA1cs demonstrated that females had higher levels, although it was minuscule. The strength of this study may be in providing new and simple graphs for clinicians as well as patients to use as a basis to assess and follow their glycemic control c Continue reading >>

Ada: New Hba1c Target Of 7.5% For Type 1 Children And Older Adults

Ada: New Hba1c Target Of 7.5% For Type 1 Children And Older Adults

Recent scientific evidence and better tools to monitor for hypoglycemia helped establish the new position statement…. Anne Peters, MD, FACP, professor at the Keck School of Medicine, University of Southern California, said during a press conference at the American Diabetes Association’s 74th Scientific Sessions, “Our goal here is to present a position statement that looks specifically at the needs of people with type 1 diabetes across the age spectrum.” “We now know that we have many, many people who are older with type 1 diabetes … who are frankly living long enough to now be dealing with the same issues that our elderly population faces. So we want this to really address those needs across the lifespan and address both the pediatric population as well as this much larger, older population.” Peters and her co-authors described the new guidelines as filling a need in the medical community as type 1 diabetes is often grouped with type 2 diabetes in adults or considered only a pediatric disease where a fear of hypoglycemia previously mandated staged glycemic targets. According to a new position statement released at the Association’s 74th Scientific Sessions, the American Diabetes Association is lowering its target recommendation for blood glucose levels for children with type 1 diabetes, to reflect the most current scientific evidence and additionally to harmonize its guidelines with those of the International Society for Pediatric and Adolescent Diabetes (ISPAD). The Association now recommends that children under the age of 19 diagnosed with type 1 diabetes strive to maintain an A1C level lower than 7.5 percent. Previously, target blood glucose levels – as measured by the A1C, a test that reflects average blood glucose levels over several months – co Continue reading >>

Tailoring Treatment To Reduce Disparities:

Tailoring Treatment To Reduce Disparities:

The American Diabetes Association (ADA) publishes the Standards of Medical Care in Diabetes annually, based on the latest medical research. The following narrative provides a summary of the 2017 updated recommendations that have been developed for clinical practice. The ADA guidelines are not intended to aid or preclude clinical judgment. The full guidelines can be accessed at ADA’s Diabetes Pro website. Tailoring Treatment to Reduce Disparities: Updated guidelines focus on improving outcomes and reducing disparities in populations with diabetes such as: Ethnic/Cultural/Sex/Socioeconomic Differences and Disparities: Provide structured interventions that are tailored to ethnic populations and integrate culture, language, religion, and literacy skills. Food Insecurity: Evaluate hyperglycemia and hypoglycemia in the context of food insecurity (FI), which is defined as the unreliable availability of nutritious food. Recognize that homelessness and poor literacy and numeracy often occur with FI. Propose solutions and resources accordingly. Comprehensive Medical Evaluation and Assessment of Comorbidities: The clinical evaluation should include conversation about lifestyle modifications and healthy living. PAs should address barriers including patient factors (e.g., remembering to obtain or take medications, fears, depression, and health beliefs), medication factors (e.g., complex directions, cost) and system factors (e.g., inadequate follow up). Simplifying treatment regimens may improve adherence. This section highlights the elements of a patient-centered comprehensive medical exam, including the importance of assessing comorbidities such as: Cognitive Dysfunction: Tailor glycemic therapy to avoid significant hypoglycemia. Cardiovascular benefits of statin therapy outweigh Continue reading >>

Setting Appropriate A1c Goals For Patients With Type 2 Diabetes

Setting Appropriate A1c Goals For Patients With Type 2 Diabetes

Condition Center Home > Clinical Essentials Setting Appropriate A1C Goals for Patients With Type 2 Diabetes Are the ADA's A1C target recommendations for type 2 diabetes patients too conservative? Or is the AACE/ACE Consensus Statement's approach too aggressive? Reviewed by Clifton Jackness, MD, Attending Physician in Endocrinology, Lenox Hill Hospital and the Mount Sinai Medical Center, New York, NY Assessment of glycemic control in patients with type 2 diabetes can be achieved through patient self-monitoring of blood glucose (SMBG) and A1C determinations.1,2 The American Diabetes Association (ADA) recommends regular A1C testing to evaluate the effectiveness of current management strategies, but the target A1C goal can vary depending on the individual patient profile as well as the set of professional consensus recommendationsand associated management philosophyto which the treating clinician adheres. According to the ADA, the generally accepted standard A1C goal for adult patients with type 2 diabetes is 7.0%.1,2 Driving A1C below this level has been shown to reduce microvascular complications. In addition, if achieved quickly after a diabetes diagnosis, this A1C goal has been associated with a long-term reduction in macrovascular disease as well.1,2 According to ADA guidelines, the standard A1C goal for adults with T2DM is 7.0%, but this can vary depending on individual patient profiles. The AACE/ACE recommendations are more aggressive, with a target A1C of ?6.5% to minimize risk of diabetes-related complications. Until large clinical trials utilizing newer therapies are done to evaluate the risks and benefits of intensive therapy, it is likely that the ADA and AACE/ACE recommendations will continue to differ. The ADA suggests that physicians may lower the A1C target Continue reading >>

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