ADA lowers A1C targets for T2, will this change your A1C goals and/or choice of therapy?

Here is an article saying that the ADA has lowered their A1C targets for T2s. Interestingly there is now a two tiered target range depending on the patients age and underlying health.

To quote from the article:

"In the past, the below-7-per cent goal was applied to most people with type 2 diabetes. But, the new guidelines note that more stringent goals, such as keeping A1C between six and 6.5 per cent, 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 (hypoglycaemia). Low blood sugar levels can be a potentially dangerous side effect of many diabetes treatments.

The new guidelines suggest that blood sugar targets should be looser (A1C between 7.5 and eight per cent) for people who are older than 65 or 70, because they’re more at risk of having complications from hypoglycaemia, as well as being more at risk of side effects from taking multiple medications."

I find it interesting that if you are in the younger group and have a history of heart disease your target is loosened, perhaps an acknowledgement that many oral drugs have increased heart disease risk. To me this would also imply earlier insulin therapy for some or even most T2's or a more aggressive dietary intervention (low carb?)

So will your goals change or will it make you more responsive to earlier insulin therapy or a more aggressive dietary intervention?

I don't think it's going to change the way I treat. I'm currently slightly below a 6 A1C. So I wouldn't need to change. As for the higher levels after 65 I just don't see myself letting it get that high. It was to much work getting it where it is. I would applaud the lower standards for the younger but not so sure about raising the standard for the not so young.

Hopefully this new lower guideline would change the way doctors treat their T2 patients. Maybe it would make cause for more agressive treatments like insulin or better diet. Type 2 is a progressive disease and if lowered guideline will cause doctors and patients to take action sooner that would be a good thing.

Gary S

I finally hit the 7's after living with T2 for over 5 years and was so excited!! I came in at 7.4...but I sure do take allot of medications. Victozia 1.8, Glimepiride 2mg, Metformin 850 3 times a day, and Metoprolol 25 others for high blood pressure and high chlorestrol..I am HAPPY!!!

The full position statement is available in Diabetes Care. I think it would be wrong to suggest that the ADA has "lowered" it's blood sugar targets. Instead, they have actually loosened them, now saying that 8% or higher may be ok. This is part of their move to "individualized" goals, and a collateral part of that is "allowing" some patients to target 6-6.5%.

In the end, the ADA still huddles in their corner, fighting for the 7% despite all that we have learned.

This doesn't really make a difference because when it comes down to treatments it's basically up to the person and the knowledge of the medical proffecion. When it goes down to it the change doesn't matter.

As someone almost 65, it pisses me off that they expect I can't manage the tight control I want to keep healthy for a few more decades, and kind of "write me off" since I'm old anyway. Bah!

It is quite a shock to realize you're being written off because certain boxes on a checklist were checked. If you are proactive and computer literate you still have a chance, if you're not well.......

I'm not sure that it says that they are writing off older PWD. I didn't read the whole article, but based on BadMoonT2's synopsis above, it says that older PWD have a higher chance of experiencing lows and have more issue with med side effects. Besides, each patient has control over their own diabetes so we can still strive for lower numbers...right?

I for one, have decided that lower is better for as long as I can achieve it. I have already made some dietary and exercise changes with that in mind. I figure that the longer I can keep my numbers lower, the better.