Targets for control in diabetes
The prevention of immediate and long term complications of Diabetes require proper management, taking into consideration associated problems. This requires clinical as well as biochemical parameters to be monitored.
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To achieve the goal of tight control of diabetes and associated problems, one should establish well defined targets. |
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Laxity may be allowed in elderly patients. |
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Certain conditions require a much tighter control, e.g. diabetes in pregnancy (GDM), in patients of diabetes with complications like maculopathy (eye damage), etc.. |
Glycemic Goals (targets for glycemic control)
Parameter |
AAFP American academy of Family Physicians |
ADA American Diabetes Association |
AACE American Academy of Clinical Physicians |
A1C level |
|
<7 % |
<or=6.5 % |
Fasting / Pre-prandial glucose (mg/dl) |
80-120 |
90-130 |
<or = 110 |
Post Prandial glucose (mg/dl) |
<180 |
<180 |
< or = 140 |
Bed time glucose (mg/dl) | 100-140 |
100-140 |
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3 AM glucose (mg/dl) | 70-110 |
OPTIMUM MANAGEMENT
|
TEST PARAMETER |
GOOD |
FAIR |
POOR
|
Venous Plasma Glucose mg/100ml | |||
|
Fasting |
80-110 |
111-125 |
>125 |
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2Hours Post Prandial |
120-140 |
141-200 |
>200 |
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Glycosylated Hemoglobin (HbA1c) Normal range:5-8 |
<8.5 |
8.5-9.5 |
>9.5 |
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Blood Pressure mm/Hg |
<130/80 |
<140/90 |
>140/90 |
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Total Cholesterol mg/100ml |
<200 |
200-240 |
>240 |
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HDL-Cholesterol mg/100ml |
>45 |
35-45 |
<35 |
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LDL-Cholesterol mg/100ml |
<100 |
100-129 |
>130 |
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Triglycerides mg/100ml |
<150 |
150-200 |
>200 |
Optimal weight.
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Ideally Body Mass Index (BMI) should be used to calculate optimal weight using the following formula. |
WEIGHT IN KG
BMI= __________________
HEIGHT IN METER
GOOD: 20-23
FAIR: 23-25
POOR: >25
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Care must be taken that the weight is not decreased below the normal limits, as a BMI of 18.5 signifies under nutrition. |
Waist Hip (W-H) ratio.
Recent evidence suggests that central obesity as judged by the Waist to Hip (W-H) ratio is important in diabetes and should be taken into consideration along with BMI.
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A W-H ratio >0.95 in men and >0.85 in women denotes risk for the development of diabetes. |
Optimum management also includes.
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Diagnosis and management of chronic diabetic complications in their earliest stages. |
Glycosylated Haemoglobin (HbA1c) test results (%) & their plasma blood glucose equivalents.
HbA1c |
Glucose |
HbA1c |
Glucose |
HbA1c |
Glucose |
HbA1c |
Glucose |
4.0 |
65 |
6.5 |
154 |
9.0 |
243 |
11.5 |
332 |
4.1 |
69 |
6.6 |
158 |
9.1 |
247 |
11.6 |
336 |
4.2 |
72 |
6.7 |
161 |
9.2 |
250 |
11.7 |
339 |
4.3 |
76 |
6.8 |
165 |
9.3 |
254 |
11.8 |
343 |
4.4 |
79 |
6.9 |
168 |
9.4 |
257 |
11.9 |
346 |
4.5 |
83 |
7.0 |
172 |
9.5 |
261 |
12.0 |
350 |
4.6 |
86 |
7.1 |
175 |
9.6 |
264 |
12.1 |
353 |
4.7 |
90 |
7.2 |
179 |
9.7 |
268 |
12.2 |
357 |
4.8 |
93 |
7.3 |
183 |
9.8 |
272 |
12.3 |
361 |
4.9 |
97 |
7.4 |
186 |
9.9 |
275 |
12.4 |
364 |
5.0 |
101 |
7.5 |
190 |
10.0 |
279 |
12.5 |
368 |
5.1 |
104 |
7.6 |
193 |
10.1 |
282 |
12.6 |
371 |
5.2 |
108 |
7.7 |
197 |
10.2 |
286 |
12.7 |
375 |
5.3 |
111 |
7.8 |
200 |
10.3 |
289 |
12.8 |
378 |
5.4 |
115 |
7.9 |
204 |
10.4 |
293 |
12.9 |
382 |
5.5 |
118 |
8.0 |
207 |
10.5 |
297 |
13.0 |
386 |
5.6 |
122 |
8.1 |
211 |
10.6 |
300 |
13.1 |
389 |
5.7 |
126 |
8.2 |
215 |
10.7 |
304 |
13.2 |
393 |
5.8 |
129 |
8.3 |
218 |
10.8 |
307 |
13.3 |
396 |
5.9 |
133 |
8.4 |
222 |
10.9 |
311 |
13.4 |
400 |
6.0 |
136 |
8.5 |
225 |
11.0 |
314 |
13.5 |
403 |
6.1 |
140 |
8.6 |
229 |
11.1 |
318 |
13.6 |
407 |
6.2 |
143 |
8.7 |
232 |
11.2 |
321 |
13.7 |
410 |
6.3 |
147 |
8.8 |
236 |
11.3 |
325 |
13.8 |
414 |
6.4 |
151 |
8.9 |
240 |
11.4 |
329 |
13.9 |
418 |
Data represent averages. Individual values may vary.
Desirable
Conversion :
HbA1c =(Plasma Blood Glucose + 77.3)/35.6
Plasma Blood Glucose =(HbA1c x35.6)-77.3.