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Category: Diabetes

Finding Common Ground for Glycated Haemoglobin Test Targets

In March of this year, the American College of Physicians (ACP) issued a guidance statement on HbA1c targets for adults with type 2 diabetes (T2D), which have been the subject of debates and discussions in the medical community. At the center of this debate is ACP’s recommendation for a target HbA1c goal between 7-8% to maintain optimal glucose control, which is higher than what’s recommended by the American Diabetes Association (ADA) or the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE).

ADA recommends a goal of <7% for HbA1c, even advocating more stringent goals (such as <6.5%) for certain patients with a low risk of hypoglycemia. The AACE/ACE guidelines recommend keeping glycated hemoglobin levels at ≤ 6.5% for most patients with low-risk of side effects.

The statement from ACP also recommends the individualization of T2D therapy, deintensification of therapy for patients that achieve HbA1c levels of less than 6.5%, and controlling symptoms rather than focusing on specific HbA1c goals in patients with a life expectancy of less than 10 years (such as patients aged 80 or older, that reside in a nursing home, or with chronic conditions – including dementia, cancer, end-stage kidney disease, severe COPD, or congestive heart failure). One of the main ideas behind this statement is to balance the benefits of lowering blood glucose with potential risks, such as important side effects (like hypoglycemia and weight gain), costs, and overall patient burden.

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The Co-Occurrence of Diabetes & Heart Disease

The number of people living with diabetes has tripled since 2000, leading to enormous financial ramifications: the global cost of the disease is $850 billion each year. The latest estimates from the International Diabetes Federation indicate that one in 11 adults worldwide have diabetes; most have type 2 diabetes, which is strongly linked to obesity and lack of exercise. There is a strong link between type 2 diabetes and cardiovascular disease, as people with diabetes are more than twice as likely to develop cardiovascular disease and lower life expectancy.

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