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 130/80 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 recently 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). The American College of Cardiology and the ADA collaborated to create a resource for physicians and people with diabetes called “Make the Link! Diabetes, Heart Disease, and Stroke” (www.diabetes.org/MaketheLink), which contains health information and an interactive, visual program explaining the link between diabetes and heart disease. You can also call the ADA at (800) DIABETES (342-2382) to order free publications such as the Diabetes Outcomes Wallet Card or “A Guide to the American Diabetes Association’s Standards of Care.” The National Diabetes Education Program (NDEP) started “Be Smart About Your Heart: Control the ABCs of Diabetes” (www.ndep.nih.gov/campaigns/BeSmart/BeSmart_index.htm), which contains links to statistics, diabetes and heart disease information, and a wallet card you can download and print. You can also call the NDEP at (800) 860-8747 to find out how to order brochures such as “Be Smart About Your Heart.”