Researchers call for review of glucose targets
medwireNews: Currently published self-monitored blood glucose (SMBG) targets are not consistent with real-world data and may force patients to aim for lower fasting levels than necessary, US researchers warn.
“Considering the safety concerns surrounding hypoglycemia, in particular, nocturnal hypoglycemia and hypoglycemia unawareness, the current recommended glucose targets emphasizing lower fasting BG and higher postprandial BG should be re-evaluated”, write Nancy Wei (Harvard Medical School, Boston, Massachusetts) and colleagues in Diabetes Care.
Wei and team used data from the multicenter, observational A1c-Derived Average Glucose study to determine the average fasting, postmeal and bedtime SMBG concentrations for five different glycated haemoglobin (HbA1c) ranges: 5.50–6.49% (37–47 mmol/mol), 6.50–6.99% (48–52 mmol/mol), 7.00–7.49% (52–58 mmol/mol), 7.50–7.99% (58–64 mmol/mol) and 8.00–8.5% (64–69 mmol/mol).
A total of 30,108 bedside BG measurements, taken from 237 patients with Type 1 diabetes and 141 with Type 2 diabetes over an average of 11 days, were included in the analysis.
The researchers found that the mean fasting BG level was 122 mg/dL in patients achieving a HbA1c level of 5.50–6.49% and 142 mg/dL in those with a HbA1c level of 6.50–6.99%. By comparison, lower BG targets of 110–115 mg/dL are recommended by the American Association of Clinical Endocrinologists (AACE) and the International Diabetes Federation (IDF) to achieve HbA1c levels ≤6.50% or <7.00%, depending on the organisation.
The postprandial BG levels were 144 mg/dL and 164 mg/dL among patients achieving HbA1c levels of 5.50–6.49% and 6.50–6.99%, respectively, which are both lower than the target of “less than 180 mg/dL” recommended by the American Diabetes Association, but similar to that recommended by the AACE (<140 mg/dL) and the IDF (136–160 mg/dL).
Of note, mean blood glucose levels were generally similar for patients with Type 1 and Type 2 diabetes in each HbA1c group, which supports the use of “a similar set of target values regardless of type of diabetes in nonpregnant adults”, Wei and co-authors remark.
They conclude that the study “establishes realistic target BG levels, based on empirical data”.
“We hope that these data will be used by professional societies, clinicians, and patients to guide the appropriate choice of glucose targets and treatment to achieve their individualized HbA1c goal.”
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014
By Laura Cowen, medwireNews Reporter