image of Women exercising fighting diabetes by Diabetes Insight Cork Ireland

 

image of Women exercising fighting diabetes by Diabetes Insight Cork IrelandThe next time you visit a member of your diabetes team, ask them is your HbA1c target individualized to you. We all recognize the fact that HbA1c targets should be under 7% but this may be a too generalized target for many people and is fast becoming an outdated approach.

Internationally diabetes care is moving to being individualized and personalized, as no two people with diabetes are the same.and should be given their own targets unique to them. Everyone with diabetes should be individually assessed, and Diabetes Insight has advocated for individualized care for people with diabetes for some time.

A joint position statement from the American College of Cardiology, ADA, and the American Heart Association recommended that although an appropriate A1C target is generally <7.0%, individualized glycaemic targets may be appropriate for some patients. For example, they stated that higher A1C targets may be more appropriate for those patients who are older, have longer duration of diabetes(over 10 years), have a history of severe hypoglycemia, exhibit advanced microvascular or macro-vascular complications [1].

For example in order for an elderly person with diabetes to have a HbA1c under 7% they possibly may be having hypoglycemic events to achieve this, putting their bodies under unnecessary stress, increasing their risk of a heart attach and making them more prone to falls [2]. Therefore a HbA1c of between 7-8% is more appropriate.

It is really important that as a person with diabetes you know what HbA1c target is appropriate to you, have a discussion with your diabetes team in relation to this and ensure this is fed back  to other members of your health care team such as your GP. Your HbA1c target should be reviewed every 3-6 months or as your circumstances change, as your HbA1c target may need to reflect these changes.

References:

[1] Skyler JSBergenstal RBonow RO, et al, Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart AssociationDiabetes Care 2009;32:187192

[2] Gerstein HCMiller MEByington RP, et al, Effects of intensive glucose lowering in type 2 diabetesN Engl J Med 2008;358:25452559

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