Selecting a Treatment Regimen
Glycemic and HbA1c Goals
Glucose Targets
ÎÎGlucose targets should be individualized and take into account
residual life expectancy, duration of disease, presence or absence of
microvascular and macrovascular complications, CVD risk factors,
comorbid conditions and risk for severe hypoglycemia. Glucose targets
should also be formulated in the context of the patient's psychological,
social, and economic status (A-1).
>> In general, therapy should target a HbA1c level of ≤ 6.5% for most nonpregnant
adults, if it can be achieved safely (D-4) (Table 3). To achieve this target HbA1c
level, FPG should usually be < 110 mg/dL and the 2-hour PPG concentration
should be < 140 mg/dL (B-2) (Table 3).
ÎÎFor women with GDM, treatment goals are a preprandial glucose
concentration of ≤ 95 mg/dL and either a 1-hour postmeal glucose
value of ≤ 140 mg/dL or a 2-hour postmeal glucose value of
≤ 120 mg/dL (D-4).
ÎFor women with pre-existing T1DM or T2DM who become pregnant,
Î
glycemic goals are premeal, bedtime, and overnight glucose values of
60 to 99 mg/dL, a peak PPG value of 100 to 129 mg/dL, and a HbA1c
value of ≤ 6.0%—only if they can be achieved safely (D-4).
CVD Risk Reduction Targets
ÎÎCVD is the primary cause of death for most persons with DM; therefore
a DM comprehensive care plan should include modification of CVD risk
factors (A-1). (Cardiovascular risk reduction targets are summarized in
Table 3).
Blood Pressure
ÎÎThe blood pressure goal for persons with DM or prediabetes is
< 130/80 mmHg (D-4).
Lipids
ÎÎTreatment targets for dyslipidemia are based on established CVD
risk reduction recommendations. In persons with DM or prediabetes
and no CVD or minimal CV risk, the LDL-C goal of < 100 mg/dL is the
primary target for therapy. The goal for non–HDL-C is < 130 mg/dL.
ÎÎFor the highest-risk patients, those with established CVD or more
than 2 major CVD risk factors, LDL-C remains the primary target for
therapy with a goal of < 70 mg/dL. The non–HDL-C treatment goal is
< 100 mg/dL (Table 3) (A-1). HDL-C values > 40 mg/dL in men and
> 50 mg/dL in women are desirable. If the triglyceride concentration
is ≥ 200 mg/dL, non–HDL-C becomes a secondary target (C-3).
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