New ADA Guidelines

The new ADA guidelines for Type 2 state that target bs for young and motivated populations is 6.0 - 6.5, and that the target for persons with other conditions and older than 65 is 7.5 to 8.0 (average bs of 165 - 180, and to have this as an average there must be levels above 200).

Does this worry anyone else? I would think that such high targets would almost guarantee complications.

Is this something we as a community should be getting upset over and making noise over?

Hi Sally - An A1c of 7.5 to 8.0 doesn't almost guarantee complications although it certainly raises the risk. Richard posted his A1c history from 1981 to the present and he had many years above 7.5 and he has had no significant complications after more than 60 years of Type 1. I'm actually more concerned that older and unhealthy Type 2s in the United States often get almost no education, tools and support from the medical system so that irrespective of targets, they have little chance of maintaining tight control.


I don't think that It's even worth about getting upset over. Anyone serious about diabetes should realize by now that the ADA is a scam.

When I was a kid, my mom would sometimes buy food that had ADA endorsements. It would drive my BG way up. They don't endorse things that are good for diabetics. Any company can buy their endorsement and use their seal to sell products to diabetics.

They still do this, only the wording on the seal is changed a little.

The ADA does a very good job advocating for Food and Pharmaceutical companies. Not such a great job of advocating for people with diabetes. It's just a shame that some doctors listen to them.

Agree with Sam. The ADA & CDA are not our advocates & never have been. ADA was against home glucose meters. Their allegiance to funding sources should be seriously questioned. However, since they unfortunately set the standards & are quoted as "the" expert, I find it cause for alarm.

Difficult to have a lower A1c following their dietary guidelines, so they promote higher A1c's. Eat more grains, take more insulin.

Gotta love the "young & motivated" term. Umm, motivated?

No one knows why some develop complications, of course, but everything should be done to lower the odds. A guideline for older diabetics that high is frightening.

My personal theory about older T1's without complications is that they used animal insulin with C-peptide.

Looking at the TuAnalyze "averages", most areas are running above the ADA goal ranges. That's perhaps 1) not very scientific as some are "by state" in the US/ Canada (ok, provinces...) and others are by country and there's a lot of blank space on the map but, nonetheless, we have an engaged community that, nonetheless is struggling to make their goal, being characterized here as "a scam"

Perhaps the ADA knows what the national average is and other numbers I haven't been able to track down (although I haven't looked all that hard...), it's not totally unreasonable to conclude "well they'll [us...] *never* get 5.5 so lets shoot for 6.0!" although some people are able to beat enough test strip out of our insurance companies or whatever else we do to achieve results <6. I'm inclined to agree w/ Maurie that the problem is education and a theoretical approach more than just having the goal where it is? If "140 BG" is "OK", which many Tu folks have reported being told, then a goal of 6.5 is about right? The way to fix that is to push it I think but people in generall don't like pushing things involving hard drugs like insulin?

Ok so I fall into the elder catagory according to that. My A1C is at 8.0 Funny I still like 40 years being an "elder"

Yes I think it is. Just my opinion though

There are no guarantees. This is about statistics. And the statistics are absolutely clear, ever since the DCCT in '93. As your blood sugar rises above about 5.5%, your risk of complications rises exponentially. It doesn't mean you will absolutely get any complication, only that on average people get complications. Non-diabetics get complications and supermen like Richard157 don't get them. But the statistics are clear. If you don't care about complications and you don't care about a shortened life then fine, keep your blood sugar higher. If I found out I had incurable cancer and three months to live, I'd probably be fine walking around at 250 mg/dl all day. But I want to live decades more, so I'll normalize my blood sugar, I'll continue to ignore the ADA and I'll make every effort to give my charitable dollars to organizations that work on my behalf (like the Diabetes Hands Foudation)

Whoops make that more like 15 years Sorry about that

I think the main "target" needs to be the American Medical Association as that'd be where insurance companies derive support for the standards of care (sic) they use, although Blue Cross has decided to go a step farther and cite Medicare as justification (sic) for their "obligation" to cover 4x strips/ day. I am not a huge fan of the ADA but have been a member for years and, as a disclaimer, was the centerfold in the April 2011 issue. At the same time, the tightwad in me wonders about a charitible organization maintaining an office on Broadway in downtown Manhattan? There's a centrifuge for some lab tied up in real estate...

Well, I'm 62 so I assume that older means in the late 70s or 80s. In that circumstance, a higher A1c target may be appropriate because tight control increases the frequency of lows and lows can increase fall risk which can be an almost immediate killer,

But the first generations of T1s all used animal insulin and their life expectancy was anything but good. My endo said that there was a longitudinal study at the Joslin that showed that people diagnosed in the days before NPH did better than those diagnosed later. His theory that the older regime of taking R before every meal and using rigid schedules was more effective than twice a day NPH.

Agreed. But another way to say that the risk of complications rises exponetially above 5.5% is that the curve begins to flatten out around 7% which is the reasoning that the original target of 7% was set after the DCCT. Tools have improved since 1993 and it is easier to achieve more aggressive targets but it's still hard work.

The other problem is that achieving tight control for Type 2s using the normal oral drug cocktail approach is probably more dangerous than achieving tight control for Type 1s using a pump or even MDI.

Type 2's still making insulin also need to be concerned about further degradation of their capacity to produce insulin by time spent above 140, in addition to other complications. These guidelines are not very helpful in this regard. This is something that happens in the short term as opposed to most of the other complications which happen over the long run.

It's easy to rail on endlessly against the ADA. If you follow their history, they tend to be wrong about pretty much everything, then gradually take a half step in the right direction, as to not admit wrongdoing.

In their defense, they do conduct an interesting study once in a while. Although generally on small test groups. With flaws of design, and of theoretical, rather than applicable value.

I'm sure at some point the ADA was better than nothing. As pointed out earlier, their BG and A1C targets are, for many of us, a step in the right direction. The problem is that if you follow their other advice (eat plenty of carbs and take lots of insulin), you are bound to spend lots of time unconscious (if not dead) with an A1C under 7.

This is true. When I was a kid, my parents subscribed to their magazine. Even used their credit card for a while.

Unfortunately, one aspect of exponential curves is that the scale can make it seem like important and significant risk reduction disappears below 7% and this is not true. Studies such as EPIC-Norfolk showed that statistically significant (and meaningful) risk reductions in retinopathy complications occured all the way down to 5.5%. It is true that the improvement going from say 6% to 5.5% is not as great as going form 7% down to 7.5%, but it is real.

And I don't think that the problem is solely the negative effect of drugs, it is also the encouragement of high carb diets. The ACCORD study had most patients in the intensive arm following a high carb diet, using insulin and medications. This was a recipe for bad outcomes either way.

Those targets are less than the average diabetic A1C levels right now, for either T1 or T2.

Those targets are not less than the A1C's of the most frequent posters here and other bulletin boards.

I know we have at least one problem you identified, but I look at the above two facts in context and I think there may actually be 2 or even 3 real problems, and those real problems seem way more significant than any ADA press release. Maybe I'm just too cynical.

re: centerfold 2011

haha that's awesome. I take back all the bad things I said about them.

I was running low (50s) when I wrote the response above and left the smiley off the end of the first sentence. Another proof that sarcasm and irony don't work on the web.

And, FWIW, not just the people w/ diabetes but heart disease, hypertension, cholesterol issues, etc. would all also benefit from exploring carbs. I still think that the problem isn't the ADA, it's the AMA that needs to be poked and prodded, with 30 million lancets if necessary....

I did use animal insulins with c-peptides for 25 years, from 1968 to 1993. Mild neuropathy( pins and needles,stiffness which comes and goes in my back, legs and feet; and improves when I am in better control)is my only complication.
I never want to have aic's pushing 8; though I daresay that I am probably around 7.5 now, due the stress and "eating southern" during my father's passing. I am working on lowering that now with low carb, higher protein and veggies, CGM use, and exercise.

I agree with you, Gerri, about the ADA. I know but a few Type 2 friends on insulin who have a1c's under 8, very few.The majority of others say their doctors tell them they are doing fine. My one Type two older woman friend(age 72) keeps her a1c in the 6's, without counting carbs and an occasional use of sliding scale, Whatever she does "works" for her.: She does check her fasting blood glucose daily and often before meals. Most of my other type 2 friends rarely check their blood sugars and are content with an 8.5, and they say their doctors are ok with that.
I do not try to be the diabetes police..I just show them how I eat when we go out or I have them in my home for dinner. They enjoy the meal choices and cannot believe they are lower carb.

God bless,