AACE: Chicago: Type 2 Diabetes Guidelines Stress Aggressive Ma

A 110mg/Dl. fasting and a postprandial BG of 140 or less need to be our new targets in glycemic control. New guidelines developed by a consensus conference call for more aggressive management and screening of type 2 diabetes, according to Dr. Jaime A. Davidson, speaking here Thursday at the 11th annual meeting of the American Association of Clinical Endocrinologists.

"For many years we thought type 2 diabetes primarily affected people in their forties and older. However, between 1990 and 1998, the largest percentage increase of new cases was among people 30 to 39 years of age and In 20% of newly diagnosed patients, some degree of complication has already begun." said Dr. Davidson.

Dr. Davidson was a co-chair of the American College of Endocrinology Diabetes Mellitus Consensus Conference, which developed the guidelines, and is a clinical associate professor of medicine at the University of Texas-Southwestern Medical School in Dallas.

Dr. Davidson believes the availability of new medications in the armamentarium against diabetes creates opportunities for more effective glycemic control even though with older medications, we were only able to strive for a hemoglobin A1c of 7%, now with new medications, we believe a revisitation of earlier guidelines was in order.

The new goal is an A1c of 6.5%," he said. "We also agreed that we should universalize the name of glycohemoglobin, and refer to it as A1c, in order to make the term easier for patients to understand."

The strategy for achieving the goal A1c levels involves new target preprandial and postprandial glucose levels. "A preprandial of less than 110 mg/dL is ideal, because such levels are associated with fewer complications," Dr. Davidson said. Because postprandial hyperglycemia is a critical factor in total glycemic burden, a postprandial glucose target of 140 mg/dL was established.

"European investigators have a goal of a postprandial of less than 135 mg/dL," he told Reuters Health. "As much as we wanted to universalize the guidelines, our panel decided 140 mg/dL was a more appropriate goal for postprandial glucose, and easier for physicians to remember. Also, the European data were not sufficient to convince the panel that 135 mg/dL was better."

A key aspect of aggressive control is early diagnosis and prevention of complications. "Because some ethnic groups have more diabetes, we don’t need to wait to start doing the screening," he said. Patients need to get into the healthcare system as soon as possible to prevent end-stage conditions.

For individuals in a high-risk group for type 2 diabetes, the panel recommends screening should begin at 30 years old. Typical risk factors that physicians should watch for include family history of diabetes; a body mass index greater than 27; hypertension and dyslipidemia; and, among women, having an infant with a birth weight greater than 9 pounds.