Attaining glycaemic targets is a key element in the fight to prevent complications from type 2 diabetes. American Diabetes Association (ADA) guidelines recommend a mean HbA1c target of lower than 7%,4 while the International Diabetes Federation (IDF) recommends a limit of 6.5%.2
Help attaining glycaemic targets with our Practical guidance to insulin management tool.
These general targets will not be practical or acceptable for all patients. Individual targets should be set based on, for example, the patient's age and general health.4 Patients with long life expectancy and no significant cardiovascular disease (CVD) may benefit from lower target levels if this can be achieved without significant hypoglycaemia.2,4 Less stringent targets might be more appropriate for patients with significant micro- and macrovascular disease and other comorbidities, or higher incidence of hypoglycaemia.2,4
Patients need continuing education and support to help them attain and maintain their HbA1c targets.2 This requires healthcare professionals to take into account clinical and psychosocial factors that may act as barriers to improving treatment. Healthcare professionals should also advise patients who cannot reach their targets that 'any improvement is beneficial'.2
Intensifying therapy to reach glycaemic targets
The progressive nature of type 2 diabetes means that for most patients, treatment will need to be intensified periodically in order to achieve or maintain HbA1c targets. However, physicians or patients sometimes avoid intensifying therapy because of concerns about hypoglycaemia or weight gain.3
Selecting appropriate agents or combinations of agents can help patients achieve glycaemic targets whilst reducing these associated risks. Eventually, most patients with type 2 diabetes will need exogenous insulin.1,2
References
1Nathan DM, Buse JB, Davidson MB et al., Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009; 32: 193-203.
2International Diabetes Federation guidelines: Global guidelines for type 2 diabetes 2005. Available at: http://www.idf.org. Accessed 21 January 2010.
3Peyrot M, Rubin RR, Lauritzen T et al., Resistance to insulin therapy among patients and providers. Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) Study. Diabetes Care 2005; 28: 2673-2679.
4American Diabetes Association. Standards of medical care in diabetes - 2010. Diabetes Care 2010; 33(Suppl 1): S11-S61.