Selecting a Treatment Regimen
Glycemic and HbA1c Goals Glucose Targets
ÎGlucose 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).
ÎFor 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, 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
ÎCVD 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
ÎThe blood pressure goal for persons with DM or prediabetes is < 130/80 mmHg (D-4).
Lipids
ÎTreatment 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.
ÎFor 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).
6
