What Are the Optimal Lab Test Targets for My Diabetic Patients?
What Are the Optimal Lab Test Targets for My Diabetic Patients?
Question: With the current "obesity epidemic," we're seeing more and more patients coming in with type 2 diabetes mellitus. However, of course there have been several updates of the various guideline recommendations governing target lab test results in these patients. What are the current best-practice blood pressure (BP), low-density lipoprotein (LDL)-cholesterol, and glycated hemoglobin (A1C) levels in type 2 diabetes?
The latest Standards of Care from the American Diabetes Association (ADA) recommend that patients who present with hypertension and concomitant type 2 diabetes should be treated to a BP < 130/80 mm Hg. The Association recommends that patients with BP > 140/90 mm Hg start immediate pharmacologic treatment to lower BP to the recommended target. Patients with BP in the intermediate range of 130-139/80-89 mm Hg should be given a 3-month trial of lifestyle and behavioral modification therapy to control BP as much as possible before starting drug therapy.
Similarly, ADA Standards of Care for LDL-cholesterol levels mandate a target of < 100 mg/dL in those patients with diabetes but no overt cardiovascular disease (CVD), and to < 70 mg/dL for those with a history of CVD (ischemia, angina, myocardial infarction, or stroke). Again, the guidelines emphasize the utility of lifestyle and behavioral modification as the first step in LDL management, but recommend drug therapy for those who are still not at goal.
The ADA's Standards of Care recommend that the general population maintain an A1C level of < 7%, while encouraging physicians to treat individual patients to get as close as possible to the normal value of < 6%. However, the ADA recognizes that in some patients, aggressive therapy may make the risk for hypoglycemia unacceptably high.
Question: With the current "obesity epidemic," we're seeing more and more patients coming in with type 2 diabetes mellitus. However, of course there have been several updates of the various guideline recommendations governing target lab test results in these patients. What are the current best-practice blood pressure (BP), low-density lipoprotein (LDL)-cholesterol, and glycated hemoglobin (A1C) levels in type 2 diabetes?
Response: Blood Pressure and LDL-Cholesterol
The latest Standards of Care from the American Diabetes Association (ADA) recommend that patients who present with hypertension and concomitant type 2 diabetes should be treated to a BP < 130/80 mm Hg. The Association recommends that patients with BP > 140/90 mm Hg start immediate pharmacologic treatment to lower BP to the recommended target. Patients with BP in the intermediate range of 130-139/80-89 mm Hg should be given a 3-month trial of lifestyle and behavioral modification therapy to control BP as much as possible before starting drug therapy.
Similarly, ADA Standards of Care for LDL-cholesterol levels mandate a target of < 100 mg/dL in those patients with diabetes but no overt cardiovascular disease (CVD), and to < 70 mg/dL for those with a history of CVD (ischemia, angina, myocardial infarction, or stroke). Again, the guidelines emphasize the utility of lifestyle and behavioral modification as the first step in LDL management, but recommend drug therapy for those who are still not at goal.
Response: About A1C Levels
The ADA's Standards of Care recommend that the general population maintain an A1C level of < 7%, while encouraging physicians to treat individual patients to get as close as possible to the normal value of < 6%. However, the ADA recognizes that in some patients, aggressive therapy may make the risk for hypoglycemia unacceptably high.
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