Based on this and other powerful evidence, aggressive blood glucose control as practiced in the DCCT and UKPDS has become the goal of self-care for most people with diabetes, and they should expect their doctors to help them achieve tight control.
To reach the target HbA1c of less than 7%, the ADA recommends aiming for the following blood glucose levels:
- Average blood glucose levels before meals should be 70–130 mg/dl.
- Blood glucose levels after meals should be less than 180 mg/dl.
If premeal blood sugar levels are consistently within the target range but the HbA1c level is still high, the ADA suggests monitoring one or two hours after meals and treating out-of-range numbers appropriately.
Ultimately, blood glucose targets must be tailored to the individual, and tight control is not for everyone. All of the studies demonstrating the value of tight blood glucose control have also shown that it is associated with an increased risk of hypoglycemia. Those who are especially prone to hypoglycemia may need somewhat higher target values. In particular, elderly adults, who can experience stroke or heart attack from episodes of hypoglycemia, and who may have a harder time recognizing symptoms of hypoglycemia, may be advised not to attempt tight control. Some people who already have severe complications (particularly end-stage kidney disease) may also be advised against tight control. Work with a health-care professional before starting a regimen of tight control.
Tight control has also been associated with weight gain, but such weight gain can be prevented or reversed. The weight gain associated with improved blood glucose control usually comes from absorbing calories that previously were eliminated in urine, overtreating hypoglycemia, and consuming more food after learning to match carbohydrate grams with insulin. Consuming fewer calories and learning to treat hypoglycemia without overtreating it can remedy the situation.
