A Major Shift in Diabetes Treatment Targets and Goals
Out with the old, in with the old and new?
In the not too distant past, patients with diabetes were managed by targeting a specific range of blood glucose values. Like anything else in the medical community, these ranges fluctuated as expert consensus and opinions changed over the years as new findings became available. As proof of this, one needs look no further than the history of the American Diabetes Association’s “Standards of Medical Care in Diabetes,” which is released annually. As an example, in 2014, the ADA changed the range of targeted fasting blood glucose from 70-130 mg/dl to 80-130 mg/dl. While this change does not appear to be overwhelming, it was decided that tight control to 70 mg/dl increased the incidence of hypoglycemia, which is recognized as a dangerous sequela of diabetes treatment. Another example is the discovery by Dr. Samuel Rahbar in 1968 that hemoglobin A1C is elevated in patients with diabetes. It took several years for this idea to take hold, but following the Diabetes Control and Complications Trial in 1993, and the United Kingdom Prospective Diabetes Study in 1998, with established HbA1C as a useful clinical marker in type 1 and type 2 diabetes respectively, the ADA agreed in 2010 that HbA1C be used in the diagnosis and monitoring of diabetes. Since then, it has been widely regarded that HbA1C should be maintained below 7 to achieve “good control,” and, more importantly, to minimize the risk of adverse cardiovascular events and improve overall survival.
In the current issue of the Journal of the American Medical Association, discus Continue reading