In this blog I would like to talk about the “numbers” in the revised guidelines for diabetes management. What do I mean by numbers?
Three sets of numbers are really important in the new guidelines. The first is the numbers to diagnose diabetes. As you can understand, the diagnosis of diabetes is serious and life-changing. For this reason, we always make sure to confirm the diagnosis with a repeat test. The “numbers” for diagnosis are a fasting blood sugar > 7.0 mmol/L , a 2 hour blood glucose > 11.1 mmol/L, an OGTT (oral glucose tolerance test where you take a glucose drink and have your blood measured 2 hours later) or a blood sugar any time > 11.1 mmol/L (especially if there are symptoms of diabetes). The new “number” is the A1c – this is the three month average of your blood glucose levels. We use this number to decide how effective the treatment of diabetes has been but now we are also going to use it to diagnose diabetes. An A1c of > 6.5% is now considered to mean that you have diabetes. An A1c between 6.0 and 6.4% is considered to be pre-diabetes. It is difficult for people to attend a blood test fasting or to take time off for a 2-hour appointment required for an OGTT. To be able to use the A1c for diagnosis makes it easier for everyone. However there are certain people that it can’t be used in, such as pregnant women, children or someone with a disorder of their red blood cells.
Another set of numbers that is important in the new guidelines are those used to diagnose diabetes in pregnancy. These numbers are different than the numbers used to diagnose diabetes as they are lower. What is important to know is that women should be screened for diabetes during their pregnancy for both their health and the health of their baby.
The last “number” I want to talk about is the A1c target for people with diabetes. As I mentioned previously, we use this number to decide how effectively your treatment is managing your diabetes. What the new guidelines suggests, is that while the target for most people is ≤7.0% for most people living with type 1 or type 2 diabetes, it is important that the target is INDIVIDUALIZED to each person living with diabetes. Everyone’s diabetes is different, whether they have type 1 or type 2, and it is affected by your other medical problems, your treatment and how long you have had it, as examples. The guidelines now provide some guidance to help health care professionals understand different patient problems and potential higher or lower A1c targets for them. So the range for A1c could be < 6.5% for some people and up to 8.5% for others. However, most people will have the target of ≤ 7.0%, because we know this level reduces complications of diabetes, especially when it is achieved early in your diabetes management.
The other target numbers are the blood glucose checks you do before and 2 hours after your meal. Again for most people, fasting and pre-meal should be 4 – 7 mmol/L and 2 hours from the start of your meal 5 – 10 mmol/L (and for some people that after meal target could be 5 – 8 mmol/L). To achieve your target A1c, meeting these glucose targets will help with the three-month average. These numbers are helpful in understanding your treatment changes, as they show the effect much more quickly than the A1c, which is taken only every 3 months. These checks are more instant feedback.
Numbers in diabetes – there are lots of them! What is important is that you understand what your target A1C is and your treatment plan to try to achieve this target. You should not worry about whether your diabetes is worse or better than someone else’s or if your doctor has given you different numbers for your blood glucose or A1c targets.