Becoming a “Triple-Goal Achiever”: Meeting Your A1C, Blood Pressure, and LDL Cholesterol Goals

A big focus of diabetes self-management is to achieve or get as close to your target numbers as possible. Meeting your goals, in turn, is a way to lower your risk of developing long-term diabetes complications such as heart disease, stroke, and kidney disease, and even death.

There are a lot of “numbers” to know and manage when you have diabetes: blood sugar levels, A1C, “>blood pressure, cholesterol, and microalbumin are the heavy hitters. You might even be focusing on other numbers, too, such as triglycerides and GFR (glomerular filtration rate). Yes, it’s a lot of work to keep up with them; it can seem like even more work to meet your goals. The good news? The actions that you take for even just one of your “numbers” can do wonders for your others, as well. Read on to learn how.

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Achieving triple treatment targets

A recent study published in the journal Diabetes Research and Clinical Practice compared long-term health outcomes of about 53,000 people with Type 2 diabetes in achieving treatment goals of an A1C less than 7 percent, LDL (bad) cholesterol of less than 100 mg/dl, and blood pressure of less than 140/90 mmHg. The study participants were divided into four groups: triple-goal achievers, dual-goal achievers, single-goal achievers, and no-goal achievers. Not surprisingly, the participants who met a higher number of these goals had better health outcomes — lower risk for macrovascular and microvascular complications, as well as death. Interestingly, though, the triple-goal achievers didn’t have a lower risk of complications or death compared with dual-goal achievers who met their LDL cholesterol target. The study authors concluded that meeting the LDL cholesterol goal has the most significant influence on long-term health.

Now, there were a few limitations to this study, such as lack of sufficient information about severity and duration of diabetes, type and amount of medication, adherence to medication, and the fact that the participants were mostly male. Nevertheless, the findings, while perhaps not too surprising, help to reinforce the importance of working towards your diabetes targets.

Getting to goal

You might be thinking that it’s easier said than done when it comes to meeting your A1C, blood pressure, and cholesterol goals. Yes, it will take some effort on your part, but it’s doable, especially if you have the support of your doctor, pharmacist, and other members of your health-care team, such as a dietitian. The steps below can help you reach your diabetes goals.

Know what you’re aiming for

It’s pretty hard to meet a goal unless you know what that goal is. For most people who have diabetes, the A1C is goal is less than 7 percent, the blood pressure goal is less than 140/90, and the LDL cholesterol goal is less than 100 mg/dl (or 70 mg/dl with heart disease). Because your goals may be different, talk with your doctor and come to an agreement about your targets. While you’re at it, find out how often you should get these numbers checked. A1C levels are usually checked between two to four times a year; blood pressure, at every regular office visit; and cholesterol, at least once a year. You might need your numbers checked more often if they are not at target.

Eat healthfully

No, you don’t need three separate diets to help you reach your diabetes targets. But, the following actions will help you lower your A1C, blood pressure, and LDL cholesterol:

• Control your carbs (carbs are found in bread, pasta, rice, cereal, fruit, legumes, milk, yogurt, and sweets): Learn about carb counting and aim to eat about the same amount at your meals and snacks each day. A reduced-carb eating plan may be an option for you, too. Work with a dietitian to come up with carb goals that are reasonable and realistic.

Slash the sodium: Shy away from processed and canned foods as much as possible, or choose lower-sodium options. Buy fresh or frozen fruits and vegetables as much as possible, and steer clear from luncheon meats and hot dogs. Skip the salt when cooking and on foods — use herbs and spices, instead.

• Be heart healthy: Aim to fill half of your plate with low-carb veggies, such as broccoli, green beans, summer squash, and salad greens. Try to eat fish at least twice a week — fresh or frozen is great (minus any breading). Canned tuna and salmon is fine too, but rinse well before eating. Focus on cooking with healthy oils like olive and canola oil. Eat at least one vegetarian meal that includes legumes (black beans, chick peas, lentils) each week, such as vegetarian chili, black beans and rice, or lentil stuffed peppers.

Get a move on

Many health experts believe that physical activity is the best “medicine.” There certainly is plenty of research that indicates exercise can lower the risk of heart disease, stroke, and death. Being physically active is also a great way to beat stress, boost your mood, and ease depression and anxiety. With some rare exceptions, most people can do some type of physical activity. There’s no need to start training for a marathon (unless you want to), but you’ll be doing yourself a big favor if you fit some activity into your day. How, you ask? It’s not that hard: walk during your lunch break or after dinner, climb stairs, march in place while watching TV, dance, walk around while chatting on the phone, use a chair exercise video (check out YouTube)…the possibilities are pretty much endless. Even getting up from your chair every 30 minutes for two or three minutes can help. The goal? Aim for at least 150 minutes of activity each week. If you have neuropathy (nerve damage), eye disease, or heart disease, get the OK from your doctor before starting an activity program.

Take your meds

I’ve talked with a lot of people who have diabetes, and many have shared that one of their personal goals is to get off as many medications as possible. It’s understandable, especially since medications have side effects and can be costly. Yet, when it comes to diabetes, it can be nearly impossible to meet all of your diabetes targets without the help of medication. Lifestyle measures, such as nutrition, activity, and weight loss definitely help, but sometimes they’re not enough. Think of medication as a tool in your arsenal to help you meet your goals. Whatever medicines you’ve been prescribed, it’s important to take them as directed. Some people don’t take their diabetes medicines if, for example, their blood sugar is within range or if they think their blood sugar may be too low. Other people stop taking their blood pressure medicine because they “feel fine.” For the most part, you still need to take your medicines, even if your A1C, blood pressure, or LDL cholesterol is at goal.

If you have side effects from any of your meds (frequent low blood sugars, dizziness, muscle pain) then it’s time for a chat with your provider to lower your dose or possibly change your medication. And it very well may be that you can stop taking one of your medications, too — just don’t stop it on your own without first checking with your doctor.

Medications are expensive, and if you’re not taking your medicines because you can’t afford them, talk with your doctor or pharmacist. Options are available, such as generic medicines or switching to another type of medicine; in addition, there are patient assistance programs available, such as NeedyMeds.org. You can also visit Partnership for Prescription Assistance’s website to find medication assistance programs.

The steps above can help you reach your diabetes goals and turn you into a triple-goal achiever!

Want to learn more about managing A1C, blood pressure, and cholesterol when you have diabetes? Read “H-B-A-1-C: What It Is and Why It Matters,” “The Pressure Is On: Hypertension and Diabetes,” and “Natural Ways to Lower Your Cholesterol.”