Doctors and patients should discuss goals of treatment together and come up with an individual planīlood sugar goals should take into account a patient's life expectancy and general health, as well as personal preferences, and include a frank discussion of the risks, benefits, and costs of medications. They examined findings from four large diabetes studies that included almost 30,000 people, and made four very important (and welcome!) new guidelines around blood sugar control. I have seen firsthand how enthusiastic attention to the A1c can be helpful as well as harmful for patients.Īnd so have experts from the Clinical Guidelines Committee of the American College of Physicians, a well-established academic medical organization. While all this sounds very orderly and clinically rational, in practice it hasn't worked very well. If the levels still weren't at goal, then it was time to start insulin injections. But if patients didn't meet those target A1c levels with diet and exercise alone, then per standard guidelines, the next step was to add medications, starting with pills. We as doctors were supposed to first encourage diet and exercise, all that good lifestyle change stuff, which is very well studied and shown to decrease blood sugars significantly. Generally, clinical guidelines have recommended an A1c goal of less than 7% for most people (not necessarily including the elderly or very ill), with a lower goal - closer to normal, or under 6.5% - for younger people. These cells last for about three months, so, the A1c is thought of as a measure of blood sugars over the prior three months. One easy, accurate way for us to measure a person's blood sugar over time is the hemoglobin A1c (HbA1c) level, which is basically the amount of sugar stuck to the hemoglobin molecules inside of our blood cells. Uncontrolled type 2 diabetes (also known as adult-onset diabetes) is associated with all sorts of very bad things: infections, angry nerve endings causing chronic pain, damaged kidneys, vision loss and blindness, blocked arteries causing heart attacks, strokes, and amputations… So of course, it made good sense that the lower the blood sugar, the lower the chances of bad things happening to our patients. However, when it comes to blood sugar control in diabetes, we have tended to treat the number, thinking that a lower number would equal better health. "Treat the patient, not the number." This is a very old and sound medical school teaching.
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