Is Your Type 2 Diabetes Care Up to Date?

By Athena Philis-Tsimikas, M.D.

Published Apr 3, 2015

By Athena Philis-Tsimikas, MD, Special to Everyday Health
This year, the American Diabetes Association (ADA) announced updated standards of medical care for people with diabetes. These are the guidelines and parameters medical professionals and diabetes care providers use to determine the most appropriate treatment plans for their patients — and they can help you better manage your diabetes as well.
Here’s a look at what’s new for 2015:

Blood-Sugar Targets

Previously, the ADA had established an average pre-meal blood sugar target range — the ideal value for your blood glucose level before eating — between 70 milligrams/deciliter to 130 mg/dL. The new values have increased this range to 80 mg/dL to 130 mg/dL. According to the ADA, this better reflects new data that compared actual average glucose levels with A1c mean values, which measure average blood glucose control over a period of two to three months. Setting the targets higher also could help prevent unwanted hypoglycemia, or low blood sugar.
Post-meal blood sugar targets remain the same, at less than 180 mg/dL.
In addition, the new standards recommend more individualized A1c targets:

• The A1c goal for non-pregnant adults ranges from less than 7.0 percent or less than 6.5 percent, depending on the individual.
• Tighter targets (6.0 to 6.5 percent) may be recommended for younger, healthier patients.
• Looser targets (7.5  to over 8.0 percent) may be appropriate for older patients and those who have more health problems or are more likely to develop hypoglycemia.
• A target of 7.5 percent is recommended for children and adolescents.
• A target of less than 6 percent (without significant hypoglycemia) is recommended for pregnant women.

Pneumonia Vaccines

A new guideline for 2015 recommends the pneumonia vaccine for people with diabetes. Everyone over age 2 should get a Pneumovax vaccination. If you are 65 or older and have had Pneumovax, the ADA recommends a Prevnar vaccine 12 months after your Pneumovax vaccination. Adults 65 years and older who have not had either vaccine should have Prevnar first, followed by Pneumovax 12 months later. Talk to your doctor about your vaccination schedule.

Heart-Disease Risk Management

For 2015, the updated standards of care now recommend a blood pressure goal of less than 140/90. For younger patients, less than 130/90 may be appropriate. Talk to your doctor about your individual blood pressure goal and whether you should take a daily aspirin to help prevent heart attack or stroke — aspirin therapy is not appropriate for everyone.
What about statins? The new guidelines for statin treatment, which is used to help lower cholesterol levels, depend on your age and risk of cardiovascular disease (CVD). These risk factors include high LDL cholesterol, high blood pressure, smoking and being overweight. If you’ve had a heart attack or have acute coronary syndromes, you are considered to have “overt CVD” and should be on a high statin dose. Your physician can determine whether you need a moderate or high dose — or none at all.

E-Cigarettes

Smoking is a health hazard for everyone, and the new standards of care explicitly state that electronic cigarettes (e-cigs) should not be considered any less harmful than conventional cigarettes. If you need help quitting, call 1-800-NO-BUTTS for free assistance.

Foot Screenings

Finally, if you have diabetes you should have a comprehensive foot exam every year to identify high-risk foot conditions. If you have neuropathy, your physician should examine your feet at every health care visit.  The 2015 updates also advise having a foot exam at every visit if you have foot deformities, a history of foot ulcers, or limited sensation in your feet.
It’s important to keep in mind that these guidelines are just that — guidelines. Every individual is unique, and you and your diabetes care team should decide what is right for you.
Athena Philis-Tsimikas, MD, is an endocrinologist and the corporate vice president for the Scripps Whittier Diabetes Institute at Scripps Health in San Diego.