Your personal target. Currently, the ADA recommends that people with diabetes in general achieve HbA1c results below 7%. individuals with diabetes who are not at risk for adverse effects of tight blood glucose control should work with their health-care team to achieve HbA1c results that are as close to normal (a result of 6% is considered normal) as possible. Other groups, including the American College of Endocrinology, the American Association of Clinical Endocrinologists, the European Association for the Study of Diabetes, and the International Diabetes Federation, advocate a target of 6.5%.
Even the carefully monitored people in the DCCT’s intensive-treatment group had to work hard to achieve that group’s average 7.3% HbA1c result. Because everyone’s health situation is unique, you need to work with your health-care team to set a HbA1c goal that will work best for you.
The big picture. Some people — and even their physicians — focus so much on controlling blood glucose levels that they forget that diabetes is more than just abnormal blood glucose. It’s important to remember that heart disease is the number one killer of people with diabetes. Although a follow-up trial to the DCCT found that lower HbA1c levels reduced the risk of heart attack and stroke, factors other than blood glucose control come into play when it comes to cardiovascular health. High blood pressure and cholesterol abnormalities, two major risk factors for cardiovascular disease, are also problems for people with diabetes.
The UKPDS researchers understood that people with Type 2 diabetes also tend to have or develop high blood pressure, so they used a subset of volunteers from the blood glucose study to study the effects of tighter blood pressure control. Their results along with those from a number of other large studies have shown that tight control of blood pressure reduces the risk of strokes, microvascular complications (such as nephropathy and retinopathy), and diabetes-related deaths in people with diabetes. The ADA currently recommends that people with diabetes aim for a blood pressure below 140/80 mm Hg.
People with Type 2 diabetes also tend to have decreased blood levels of high-density lipoprotein (HDL) cholesterol (the so-called “good” cholesterol) and high blood levels of triglycerides (fat). Current ADA recommendations are to first get low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol) levels below 100 milligrams per deciliter. After that has been achieved, HDL cholesterol levels should be raised above 40 milligrams per deciliter in men (or above 50 milligrams per deciliter in women) and triglyceride levels should be lowered below 150 milligrams per deciliter.
To remind people that controlling cholesterol and blood pressure are also important components of diabetes care, national health groups began a concerted effort to get the word out with nationwide campaigns and catchy slogans involving the letters “ABC” (for A1C, blood pressure, and cholesterol). You can also call the ADA at (800) DIABETES (342-2382) to order free publications such as the Diabetes Outcomes Wallet Card.
Although another fingerstick and another blood test may seem redundant to people who monitor their blood glucose levels three or more times per day, self-monitoring of blood glucose and HbA1c tests actually work together and don’t just rehash the same information.
Use in therapy. Using a home blood glucose meter allows people with diabetes to fine-tune their diabetes regimen and detect low blood glucose levels (hypoglycemia). Blood glucose monitoring several times a day gives people the opportunity to adjust insulin doses before meals and to know if a snack is needed before or after exercising.