Treating
Diabetes Mellitus
American Diabetes Association (ADA). Standards of medical care in diabetes. V. Diabetes care. Diabetes Care 2008 Jan;31(Suppl 1):S16-24.
Treatment aimed at lowering blood glucose to normal, or near normal, levels
in patients with diabetes mellitus has the following benefits:
- Reduces risk for development or progression of retinopathy, nephropathy
and possibly neuropathy.
- May result in a less atherogenic lipid profile.
- May reduce the risk for of myocardial infarction and sudden death.
Summary of Recommendations for Adults with Diabetes
Glycemic Control |
| Hemoglobin A 1C |
<7.0%* |
| Preprandial capillary plasma glucose |
70-130 mg/dL (5.0-7.2 mmol/L) |
| Peak postprandial capillary plasma glucose** |
<180 mg/dL (<10.0 mmol/L) |
Blood pressure
Initial anti-hypertensive drug of choice: an ACE-inhibitor or an Angiotensin Receptor Blocker |
<130/80 mmHg |
| Lipids*** |
| Low-density lipoprotein (LDL) |
<100 mg/dL (<2.6 mmol/L) |
| Triglycerides |
<150 mg/dL (<1.7 mmol/L) |
| High-density lipoprotein (HDL) |
>40 mg/dL (>1.1 mmol/L)**** |
Key concepts in setting glycemic goals:
- A1C is the primary target for glycemic control.
- Goals should be individualized.
- Certain populations (children, pregnant women, and elderly) require special considerations.
- Less intensive glycemic goals may be indicated in patients with severe or frequent hypoglycemia.
- More stringent glycemic goals (i.e., a normal A1C, <6%) may further reduce complications at the cost of increased risk of hypoglycemia (particularly in those with type 1 diabetes).
- Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals.
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Anti-platelet in Diabetes
Use aspirin therapy (75–162 mg/day) as a primary prevention strategy in those with Type 2 diabetes at increased cardiovascular risk, including those who are >40 years of age or who have additional risk factors: family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria.
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