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July 31, 2006

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Question from Tyler, Texas, USA:

I am a diabetes educator studying for my CDE exam for October 2006. The blood sugar goals, as recommended by the ADA for fasting is 90 to 130 mg/dl [5.0 to 7.2 mmol/L]. Has it always been at this range? I thought it was 80 to 120 mg/dl [4.4 to 6.7 mmol/L], but recent ADA recommendations state the former. I am aware that the American Association of Clinical Endocrinologists (AACE) has stricter guidelines for blood sugar control. My patients often ask about why ADA guidelines are higher.

Answer:

It’s a long story. When the original meters came out, they measured whole blood. Now, they measure plasma, which is 10 to 15% higher than whole blood. So, the ADA changed to match the change in the meters. AACE took the opportunity to lower the recommended values by not changing.

It really doesn’t matter in practice. Now, we think more about a target glucose and then do corrections based on that target….at least I do and most do with the pumps. I use 120 mg/dl [6.7 mmol/L] as the target for most, but 150 mg/d [8.3 mmol/L] for my youngest patients, within the guidelines for children from ADA. Most importantly, if we get patients to either of the targets, the diabetes control will be spectacular, the A1c great and complications prevented. This is all splitting hairs as the average A1c in America is well over 8.0. Only 5% of patients have glucose, blood pressure and lipids controlled.

LD