Glycemic Goals in Diabetics

Dr. Jagjit Khosla

Junior Resident,

Endocrinology,

GTBH

Glycemic goals in diabetics

ADAGuidelines

AACE Guidelines

IDF Guidelines

Fasting Glucose

70-130 mg/dL <110 mg/dL <115 mg/dL

Post Prandial Glucose

<180 mg/dL(Peak)

<140 mg/dL <160 mg/dL

HBA1C < 7% ≤ 6.5% < 7%

Individualising glycemic goals

• ADA Criteria for assessing individual goals

– Duration of diabetes

– Age/ Life expectancy

– Comorbid conditions

– Known CVS disease or advanced microvascular

complications

– Hypoglycaemic unawareness

Reference : ADA Guidelines 2013

Individualising glycemic goals

• HBA1C < 7%– Nonpregnant adults

• HBA1C < 6.5% (More stringent)– Short duration of diabetes

– Long life expectancy

– No significant CVD risk

• HBA1C < 8% (Less stringent)– History of Severe hypoglycemia

– Limited life expectancy

– Advanced micro- or macro-vascular complications

– Extensive comorbid conditions

– Long standing diabetes

Reference : ADA Guidelines 2013

Glycemic goals – Diabetic Children

• Hypoglycemic unawareness upto 6-7 years

• Risk for permanent cognitive impairment after

severe hypoglycemia in children below 5 yrs

Long-term health benefits

Adverse effects on development

Reference : ADA Guidelines 2013

Glycemic goals – Diabetic Children

Before meal Blood Sugar

Bedtime/Overnight Blood Sugar

HBA1C

Toddler & Preschool (0-6 years)

100-180 mg/dL 110-200 mg/dL < 8.5%

School Age (6-12 years)

90-180 mg/dL 100-180 mg/dL < 8%

Adolescents & Young(13-19 years)

90-130 mg/dL 90-150 mg/dL < 7.5%

Reference : ADA Guidelines 2013

Glycemic goals in GDM

Pre-prandial Blood Sugar ≤ 95 mg/dL

1-hr Post meal Blood Sugar ≤ 140 mg/dL

2-hr Post meal Blood Sugar ≤ 120 mg/dL

OR

+

Reference : Metzger BE et al, Summary and recommendations of the Fifth International Workshop – Conference on GDM. Diabetes Care 2007, 30(Suppl.2):S251-S260)

Glycemic goals in Diabetics

who become pregnant

Premeal, Bedtime & Overnight B. S. 60 – 99 mg/dL

Peak Post-prandial B. S. 100 – 129 mg/dL

HBA1C < 6%

Reference : Kitzmiller JL et al, Managing pre-existing diabetes for pregnancy : Summary of evidence & consensus recommendations for care. Diabetes Care 2008; 31:1060-1079

Glycemic goals in Hospital setting

• Critically ill patients

– Goal – 140-180 mg/dL

– If hypoglycemia can be avoided, 110-140 mg/dL

• Non-critically ill patients

– Premeal B.S. goal <140 mg/dL

– Random B.S. goal <180 mg/dL

– Less stringent goals in pts with severe comorbidities.

Reference : ADA Guidelines 2013

Health benefits of strict glycemic goals

• UKPDS (UK Prospective Diabetes Study) – Type 2 DM

• DCCT (Diabetes Control & Complications Trial) – Type 1 DM

1. Lower risk of microvascular complications

2. Slows the progression of existing complications

3. Long-term reduction in macrovascular complications (esp.young

diabetics)

Thank you