Building Competency in Diabetes Education THE ESSENTIALS

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GLYCEMIC THERAPEUTIC GOALS

Goals for glycemic control in diabetes are directly related to lowering the risk for the microvascular and macrovascular complications associated with hyperglycemia and are applicable to both type 1 and 2 diabetes (4). The goal of optimal diabetes management includes all of the following indicators of good control: • 1. Achieving individualized glycemic targets • 2. Multifactorial risk reduction strategies for chronic complications prevention, including achieving targets for blood pressure and lipid control • 3. Avoiding severe hypoglycemia/hyperglycemia • 4. Maintaining quality of life Each goal will be discussed individually, with an emphasis on translating them for patients. 1. Achieving individualized glycemic targets The 2018 and 2021 Guidelines acknowledge that microvascular and macrovascular complications are associated with chronic hyperglycemia (1,4,5,6). Current guidelines continue to support individualization of glycemic targets with thoughtful consideration of each person’s circumstances and diabetes specific features (type, duration, therapy, etc.). When discussing targets for diabetes control, health-care providers need to integrate the best available evidence with each individual’s experience, preference and sociodemographic profile, diabetes characteristics and comorbidities. The Diabetes Control and Complications Trial (DCCT) (7) concluded that improved glycemic control in type 1 diabetes is associated with significantly decreased microvascular complications. The follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) (8) study found benefits persist even if glycemic control deteriorates over time. In type 2 diabetes, two landmark studies - the Kumamoto Study (9) and the UK Prospective Diabetes Study (UKPDS) (10) - confirmed the association of intensive glycemic control with decreased microvascular complications. Therefore, achieving A1C <7.0% remains important to reduce microvascular complications of uncontrolled diabetes in people with type 1 and type 2 diabetes and mortality in type 1 diabetes.