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                Targets for control

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[Screening for diabetes] [High risk group] [Diagnosis guidelines] [Criteria for diagnosis] [Investigations protocol] [Diabetes in pregnancy] [Targets for control] [Diet Advise] [Exercise] [Complications] [Management] [Drug action]

 

Targets for control in diabetes

 

           

The prevention of immediate and long term complications of Diabetes require proper management, taking into consideration associated problems. This requires clinical as well as biochemical parameters to be monitored.

 

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To achieve the goal of tight control of diabetes and associated problems, one should establish well defined targets.

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Laxity may be allowed in elderly patients.

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Certain conditions require a much tighter control, e.g. diabetes in  pregnancy  (GDM), in patients of diabetes with complications like maculopathy (eye damage), etc..

 

 

Glycemic Goals (targets for glycemic control)

 

Parameter

AAFP

American academy of Family Physicians

ADA

American Diabetes Association

AACE

American Academy of Clinical Physicians

A1C level

 

<7 %

<or=6.5 %

Fasting / Pre-prandial glucose (mg/dl)

80-120

90-130

<or = 110

Post Prandial glucose (mg/dl)

<180

<180

< or = 140

Bed time glucose

(mg/dl)

100-140

100-140

 

3 AM glucose

(mg/dl)

70-110    

 

 

 OPTIMUM MANAGEMENT

 

    TEST PARAMETER          

GOOD

FAIR

        POOR

 

  Venous Plasma Glucose mg/100ml

Fasting

 80-110

111-125

>125

2Hours Post Prandial

120-140

141-200

>200

Glycosylated Hemoglobin (HbA1c) Normal range:5-8

<8.5

8.5-9.5

>9.5

Blood Pressure mm/Hg

<130/80

<140/90

>140/90

Total Cholesterol mg/100ml

<200

200-240

>240

HDL-Cholesterol mg/100ml

>45

35-45

<35

LDL-Cholesterol mg/100ml

<100

100-129

>130

Triglycerides mg/100ml

<150

150-200

>200

 

 

Optimal weight.

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Ideally Body Mass Index (BMI) should be used to calculate optimal weight using the following formula.

 

                              WEIGHT IN KG

         BMI=         __________________

                            HEIGHT IN METER   

 

GOOD: 20-23

FAIR:   23-25

POOR:    >25

 

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Care must be taken that the weight is not decreased below the normal limits, as a BMI of 18.5 signifies under nutrition.

 

Waist Hip (W-H) ratio.

Recent evidence suggests that central obesity as judged by the Waist to Hip (W-H) ratio is important in diabetes and should be taken into consideration along with BMI.

 

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A W-H ratio >0.95 in men and >0.85 in women denotes risk for the development of diabetes.

 

Optimum management also includes.

 

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Diagnosis and management of chronic diabetic complications in their earliest stages.

 

 

Glycosylated Haemoglobin (HbA1c) test results (%) & their plasma blood glucose equivalents.

 

HbA1c

Glucose

HbA1c

Glucose

HbA1c

Glucose

HbA1c

Glucose

4.0

65

6.5

154

9.0

243

11.5

332

4.1

69

6.6

158

9.1

247

11.6

336

4.2

72

6.7

161

9.2

250

11.7

339

4.3

76

6.8

165

9.3

254

11.8

343

4.4

79

6.9

168

9.4

257

11.9

346

4.5

83

7.0

172

9.5

261

12.0

350

4.6

86

7.1

175

9.6

264

12.1

353

4.7

90

7.2

179

9.7

268

12.2

357

4.8

93

7.3

183

9.8

272

12.3

361

4.9

97

7.4

186

9.9

275

12.4

364

5.0

101

7.5

190

10.0

279

12.5

368

5.1

104

7.6

193

10.1

282

12.6

371

5.2

108

7.7

197

10.2

286

12.7

375

5.3

111

7.8

200

10.3

289

12.8

378

5.4

115

7.9

204

10.4

293

12.9

382

5.5

118

8.0

207

10.5

297

13.0

386

5.6

122

8.1

211

10.6

300

13.1

389

5.7

126

8.2

215

10.7

304

13.2

393

5.8

129

8.3

218

10.8

307

13.3

396

5.9

133

8.4

222

10.9

311

13.4

400

6.0

136

8.5

225

 11.0

314

13.5

403

6.1

140

8.6

229

 11.1

318

13.6

407

6.2

143

8.7

232

 11.2

321

13.7

410

6.3

147

8.8

236

11.3

325

13.8

414

6.4

151

8.9

240

11.4

329

13.9

418

 

Data represent averages. Individual values may vary.

 

 Desirable

 

Conversion :

HbA1c =(Plasma Blood Glucose + 77.3)/35.6

Plasma Blood Glucose =(HbA1c x35.6)-77.3.

 

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