Miriam E. Tucker
February 13, 2014
Current glycemic targets advised for diabetes patients don’t align with recommended HbA 1c levels, a new analysis of continuous glucose monitoring data suggests.
The findings, from the A 1c-Derived Average Glucose (ADAG) study, were published online February 10 in Diabetes Care by Nancy Wei, MD, from the Diabetes Center at Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues.
Professional societies’ recommendations for diabetes management advise HbA 1c goals of 6.5% or less, or less than 7%, with individualization based on a variety of factors. But HbA 1c is measured only once every 3 months, and day-to-day self-management of diabetes to achieve and maintain the individualized target HbA 1c is facilitated by self-monitored blood glucose (SMBG) values, especially in patients treated with insulin.
Accordingly, SMBG targets are provided to patients to achieve HbA 1c goals, but these are based predominantly on expert opinion and, as a result, vary widely, the investigators say. Consequently, “There is little to guide clinicians and patients on how to achieve…individualized, targets,” they observe.
“Considering the safety concerns surrounding hypoglycemia, in particular, nocturnal hypoglycemia and hypoglycemia unawareness, the current recommended glucose targets emphasizing lower fasting blood glucose and higher postprandial blood glucose should be reevaluated,” they urge.
Separate Targets Not Necessary for Type 1 vs Type 2
Target blood glucose levels needed to achieve specific HbA 1cgoals were generally similar for patients with type 1 and type 2 diabetes, suggesting that separate targets aren’t necessary for the 2 patient groups, the authors say.
They emphasize that the choice of both HbA 1c goals and self-monitored blood glucose targets is complex and should be based on individual patient factors.
“We hope that these data will be used by professional societies, clinicians, and patients to guide the appropriate choice of glucose targets and treatment to achieve their individualized HbA 1c goal.”
Dr. Wei was supported by a National Institute of Diabetes and Digestive and Kidney Diseases training grant. Disclosures for the coauthors are listed in the article.
Diabetes Care. Published online February 10, 2014. Abstract