Building Competency in Diabetes Education THE ESSENTIALS

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Table 1. Targets for A1c .(4) as per the Clinical Practice Guidelines 2018

Reproduced with the permission of Diabetes Canada (4)

In Consideration of High Risk Populations Three landmark trials - Action to Control Cardiovascular Risk in Diabetes (ACCORD) (11,12), Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) (13), and Veterans Affairs Diabetes Trial (VADT) (14), demonstrated intense efforts required to achieve near normoglycemia and potential risks of intensive therapy in high risk population groups. Findings from the ACCORD, ADVANCE and VADT studies suggested no significant reduction in cardiovascular outcomes with intensive control in people with long-standing type 2 diabetes (8-11 years) and either known cardiovascular condition or present risk factors. Also, the three studies found that the severity and frequency of hypoglycemia was significantly increased in the intensive control group (11 14). What are the implications for practice from the available evidence? Educators need to remain vigilant for risks associated with intensive control which may outweigh the benefits in patients with long duration of diabetes, high risk of hypoglycemia, advanced age and cardiovascular risk. These population groups may need modification of therapeutic regimens and less stringent goals for glycemic control Therefore, it is very important to establish realistic, individualized BG targets with each person with diabetes. For most, the target should be 4.0 to 7.0 mmol/L fasting plasma glucose (FPG) or before meals (pre-prandial) and 5.0-10.0 mmol/L after meals (postprandial [PPG]). However, if the A1C target of 7.0% or less cannot be achieved with the above targets, individuals should be encouraged to aim for FPG 4.0-5.5 mmol/L and/or