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American Diabetes Association (ADA) management goals for diabetic patients.

The American Diabetic Association (ADA) along with federal and International health authorities have recently issued new guidelines for diagnosing diabetes. The new fasting blood sugar(glucose) level for diagnosing diabetes mellitus has been dropped from 140 to 126 mg/dl. Experts say new screening policy could help unmask 2 million cases of diabetics in this country alone. The guidelines recommend testing all people at age 30 and repeating the test every 3 years. Testing should begin earlier and be repeated more frequently for those at higher risk. The goal is to start treatment sooner rather than later and hopefully avoid some of the serious complications of the disease.

Complications from heart diseases are the leading causes of death and disability in diabetic patients.
Studies have shown that:

  • Diabetes patients have a 2-to 4- fold excess risk of heart attacks
  • 2-to 3-times greater risk of death after a heart attack
  • Poorer prognosis after balloon angioplasty or bypass operation
  • 2- to 3-fold greater risk of stroke
  • Heart disease tends to develop sooner in the diabetic population than in the non-diabetic

The reason for these excessive risks in the diabetic population is not completely understood, but we know from evidence based medicine that when certain risk factor are controlled in this population, you can substantially reduce 'heart disease-related' death rate and disability in the diabetic patients. Generally speaking, the thing to remember is that treatment goals or endpoints for blood pressure and lipid levels for them are lower than those for the general population.

Here is a summary of the ADA recommendations: Blood Pressure should be 130/85 mm Hg or lower. Should be checked at every office visit (at least 3 times per year for patients with type 2 diabetes and 4 times per year for those with type 1 diabetes).

Fasting blood glucose should be maintained at 126mg/dl or less.

Glycosylated hemoglobin (HbA1c) should be less than 6.5%. This should be tested 3-4 times a year. 4 times for type 1 diabetes and 3 times for type 2 diabetes.

Albumin excretion should be less than 30 mg/24hours.

  • The recommendation is to test for microalbumin in the urine if no protein is picked on routine dipstick method.
  • Start screening for protein excretion in the urine 5 years after onset of type 1 diabetes and from the time of diagnosis of type 2 diabetes.

Cholesterol should be checked yearly; if repeatedly normal can be spread out to every two years.

  • HDL cholesterol (the good cholesterol) should be greater than 45 mg/dl; levels much higher than this are recommended for women.
  • LDL cholesterol (the bad cholesterol) should be less than 100 mg/dl.
  • Triglyceride levels should be less than 200 mg/dl

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