For many individuals with type 2 diabetes and their doctors, managing this troublesome condition is all in regards to the numbers. A number, to be exact: the hemoglobin A1c reading. This is a measure of average blood sugar levels over the past three months. New guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes recommend a more “patient-centered approach” to the management of type 2 diabetes.
Type 2 diabetes occurs when an individual's muscle cells stop responding to the hormone insulin produced by the pancreas. You can consider insulin as a tiny molecular key that unlocks the door through which glucose (blood sugar) flows into the cells. When muscle cells resist insulin's “open-up” signal, blood glucose builds up. Over time, it damages tissues throughout the body, from the brain to the fingers. It can damage nerves, block vision and cause heart disease.
An easy method to check blood sugar is to measure the proportion of hemoglobin molecules (the oxygen-carrying protein in red blood cells) which have been coated with glucose. This is generally known as the hemoglobin A1c (HbA1c) test. The higher the typical every day blood sugar over a three-month period, the upper the HbA1c value.
People who do not need diabetes have an HbA1C reading of lower than 5.7%. For a few years, the American Diabetes Association has really useful that nearly everyone with type 2 diabetes should keep an HbA1c level below 7 percent. Keeping blood sugar as little as possible, generally known as “tight control,” was thought to limit the devastation brought on by diabetes.
But a series of studies show that tight control doesn't improve life or longevity in individuals who have had diabetes for a few years. And for some people, attempting to keep blood sugar low enough to hit the HbA1C goal of seven% or less means experiencing episodes of low blood sugar (hypoglycemia). Hypoglycemia could cause blackouts, seizures, and paralysis. In older people, repeated bouts of low blood sugar can impair brain function.
One size doesn't fit all.
The latest guidelines recognize that folks are different. TheADAnow recommends that individuals and their doctors choose blood sugar goals together.
For people newly diagnosed with type 2 diabetes but who're otherwise in good health, the ADA still recommends that they aim for tighter control. For them, an HbA1C of 6.0% to six.5% is good. This is particularly true if the goal can only be achieved with lifestyle changes (akin to dropping pounds and getting more exercise), or with lifestyle plus the drug metformin (Generic, Glucophage, Fortamet).
For individuals who have had diabetes for some time, an HbA1c goal of seven.5% to eight.0%, and even higher, could also be more appropriate. Reasons for “loosening” blood sugar include:
- old age
- Frequent episodes of hypoglycemia.
- Presence of other medical conditions requiring multiple medications and requiring greater than 2 medications to lower blood sugar.
- Limited financial resources
Controlling blood sugar is barely one a part of managing type 2 diabetes to limit its health effects. Controlling weight and blood pressure is critical, as are efforts to stop heart disease, stroke, and kidney disease, all of which may result from diabetes.
These latest patient-centered recommendations are a breath of fresh air. They might be good for individuals with type 2 diabetes and their doctors. Patient-centered care must be a central theme. All health guidelines.