New Guidelines on Blood Sugar 2012, Released!
recommendations are a joint effort by the American Diabetes Association and the
European Association for the Study of Diabetes.
The new guidelines are scheduled to be published in the June issue of
Diabetes Care, but were
released online ahead of publication on April 19.
According to Dr. Vivian Fonseca, president of medicine and science for the
American Diabetes Association, The new guidelines were necessary because the
management of type 2
diabetes is becoming increasingly complex; there is a widening array of
medications available to treat the disease, and new research studies are
constantly being released highlighting both the benefits and the risks of
: The biggest change in the new
guidelines is an emphasis on a patient-centered approach to treatment.
For example, the blood sugar goal for someone who's young, healthy and
motivated to manage type 2 diabetes will be lower than it is for someone
who's elderly and has additional
Individualized Blood Sugar Goal
sugar goals are usually expressed in terms of hemoglobin A1C levels (HbA1C).
HbA1C, often just referred to as A1C, is a measure of long-term blood sugar
control. It gives an estimate of what the average blood sugar level has been for
the past two to three months. A1C is expressed as a percentage, and in general,
the goal for people with type 2 diabetes is to lower their A1C levels below 7
percent. Someone without diabetes generally has levels below 5.6 percent,
according to the American Diabetes Association.
The below-7-percent goal has been applied to most people with type 2 diabetes.
But, the new guidelines note that more stringent goals, such as keeping A1C
between 6 and 6.5 percent, might be appropriate for someone who has a long life
expectancy, no history of
heart disease and who hasn't experienced significant low blood sugar levels
Low blood sugar levels can be a potentially dangerous side effect of many
The new guidelines suggest that blood sugar targets should be lower (A1C between
7.5 and 8 percent) for people who are older than 65 or 70, because they're more
at risk of having complications from hypoglycemia, as well as being more at risk
of side effects from taking multiple medications.
changes: remain an important part of type 2 diabetes management plan in the
new guidelines. The recommendations are to lose 5 percent to 10 percent of
and to participate in modest
for at least two-and-a-half hours each week.
Medication: The medication metformin is recommended as a
first-line treatment for people with type 2 diabetes. Metformin works by
making the body more receptive to the hormone insulin. Metformin therapy
should begin as soon as someone is diagnosed with type 2 diabetes, unless
they have a near-normal A1C and are highly motivated to make lifestyle
changes. In such a case, doctors may choose to follow up with the
patient in three to six months to see if the lifestyle changes have been
effective. If not, metformin should be started.
The new guidelines recommend adding another drug to metformin therapy if
blood sugar levels aren't under control after three months on metformin
alone. Again, this is an area where the patient needs to be considered and
consulted. Each additional treatment option has its own risks and benefits.
Talk to your doctor about which might be right for you.
The focus is to -Treat the patient and not the blood sugar. The
medication needs to be tailored to the patho-physiology of the patient.
Dated 20 April 2012