Progress or Regression? US Physicians' New Relaxed Blood Sugar Targets Explained
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In March of this year, the American College of Physicians (ACP) recommended in a statement in the Annals of Internal Medicine:
1. The glycated hemoglobin (HbA1c) control target for non-gestational type 2 diabetes (T2DM) adults is changed from the original 6.5%-7% to 7%-8%.
2. Clinicians should discuss the benefits and harms of drug therapy, T2DM patient preferences, general health and life expectancy, treatment burden and cost, and then develop individual glycemic control goals.
3. For T2DM patients whose HbA1c is below 6.5%, the dose of periodic drugs should be reduced or the types of drugs should be reduced.
4. The primary goal of treating T2DM is to reduce symptoms related to hyperglycemia. HbA1c control in patients with T2DM who are 80 years of age and older, have a life expectancy of less than 10 years, live in nursing homes, and have chronic medical conditions (such as dementia, cancer, end-stage renal disease, severe chronic obstructive pulmonary disease, or congestive heart failure) Being at a lower level can do more harm than good.
Why is it recommended to relax blood sugar control standards?
Some people with diabetes do not understand the relaxation of standards. It seems that without the promise of blood sugar, a protective umbrella for disease control that has been fully explained, everything has become dangerous and unpredictable, and they have no peace of mind.
In the past, the standard for glycated hemoglobin was 6.5%. At that time, even the compliance rate of diabetic patients treated at STENO, an internationally renowned diabetes center in Denmark, was only about 15%. At that time, doctors often felt that the standard of glycated hemoglobin lower than 6.5% was out of reach. Even if it could be achieved for a while, it would be difficult to maintain it, or patients would suffer from frequent hypoglycemia when reaching this standard. The source of the data of 6.5% is estimated to be the statistical upper limit of HbA1c value for people with normal blood sugar. It is found that people who can reach this limit often have a shorter illness time, such as within 3-5 years, and the drugs they use will not cause hypoglycemia. People have stricter diets and generally have higher exercise levels.
In the past ten years, in the treatment of diabetes, HbA1c less than 7% has generally been set as the target for blood sugar control. According to this standard, after ordinary patients work hard, patients with a disease duration of less than 8-10 years can often reach 40-40 within 3-6 months. 50% compliance rate (can be confirmed by many studies). And when we look at all patients and extend the observation period (for example, 2-3 years), the people whose HbA1c reached the target of less than 7% dropped again to 15-25%. The overall feeling is that only a few people can achieve optimal results in the long term. standards.
So does this mean that the vast majority of people still have poor blood sugar control and need to constantly adjust (addition of medications or lifestyle adjustments, and also need to reduce diet or increase exercise), and for those elderly people who have been unable to change? Patients, in fact, even if they try new drugs, the possibility of maintaining "good" blood sugar for a long time is not very high, or even if it reaches the ideal standard, they may become more uncomfortable, either with frequent hypoglycemia or simply afraid to eat.
Blood sugar control standards should vary from person to person
Specific sugar control standards should be grasped individually and vary from person to person. On the premise of ensuring the safety of patients with diabetes, the effectiveness of blood sugar control is also taken into account. This standard has a lot to do with the age, duration of illness, background of cardiovascular and cerebrovascular diseases, and the anti-diabetic drugs used by patients with diabetes. Therefore, in order to obtain appropriate standards for a patient's blood sugar control, it is necessary to understand the patient's entire condition, and it is best to follow up the patient's condition for a long time.
Relaxing sugar control standards is a kind of progress and regression
The current blood sugar standard announced by the United States shows that the diabetes academic community is getting rid of the idea of blood sugar first and blood sugar as the main focus, and is gradually moving towards comprehensive and comprehensive control of diabetes. At the same time, it has truly entered a people-oriented and data-assisted stage at the clinical operation level. . Normalization of indicators is relatively less rigid and dogmatic. What we urgently need to do now is to consider blood sugar instead of just blood sugar, and provide comprehensive management so that patients can benefit comprehensively. While treating the disease, they will also have a better quality of life and a better future. This is what we have always been doing. The real therapeutic goal that has been pursued since.
1. The glycated hemoglobin (HbA1c) control target for non-gestational type 2 diabetes (T2DM) adults is changed from the original 6.5%-7% to 7%-8%.
2. Clinicians should discuss the benefits and harms of drug therapy, T2DM patient preferences, general health and life expectancy, treatment burden and cost, and then develop individual glycemic control goals.
3. For T2DM patients whose HbA1c is below 6.5%, the dose of periodic drugs should be reduced or the types of drugs should be reduced.
4. The primary goal of treating T2DM is to reduce symptoms related to hyperglycemia. HbA1c control in patients with T2DM who are 80 years of age and older, have a life expectancy of less than 10 years, live in nursing homes, and have chronic medical conditions (such as dementia, cancer, end-stage renal disease, severe chronic obstructive pulmonary disease, or congestive heart failure) Being at a lower level can do more harm than good.
Why is it recommended to relax blood sugar control standards?
Some people with diabetes do not understand the relaxation of standards. It seems that without the promise of blood sugar, a protective umbrella for disease control that has been fully explained, everything has become dangerous and unpredictable, and they have no peace of mind.
In the past, the standard for glycated hemoglobin was 6.5%. At that time, even the compliance rate of diabetic patients treated at STENO, an internationally renowned diabetes center in Denmark, was only about 15%. At that time, doctors often felt that the standard of glycated hemoglobin lower than 6.5% was out of reach. Even if it could be achieved for a while, it would be difficult to maintain it, or patients would suffer from frequent hypoglycemia when reaching this standard. The source of the data of 6.5% is estimated to be the statistical upper limit of HbA1c value for people with normal blood sugar. It is found that people who can reach this limit often have a shorter illness time, such as within 3-5 years, and the drugs they use will not cause hypoglycemia. People have stricter diets and generally have higher exercise levels.
In the past ten years, in the treatment of diabetes, HbA1c less than 7% has generally been set as the target for blood sugar control. According to this standard, after ordinary patients work hard, patients with a disease duration of less than 8-10 years can often reach 40-40 within 3-6 months. 50% compliance rate (can be confirmed by many studies). And when we look at all patients and extend the observation period (for example, 2-3 years), the people whose HbA1c reached the target of less than 7% dropped again to 15-25%. The overall feeling is that only a few people can achieve optimal results in the long term. standards.
So does this mean that the vast majority of people still have poor blood sugar control and need to constantly adjust (addition of medications or lifestyle adjustments, and also need to reduce diet or increase exercise), and for those elderly people who have been unable to change? Patients, in fact, even if they try new drugs, the possibility of maintaining "good" blood sugar for a long time is not very high, or even if it reaches the ideal standard, they may become more uncomfortable, either with frequent hypoglycemia or simply afraid to eat.
Blood sugar control standards should vary from person to person
Specific sugar control standards should be grasped individually and vary from person to person. On the premise of ensuring the safety of patients with diabetes, the effectiveness of blood sugar control is also taken into account. This standard has a lot to do with the age, duration of illness, background of cardiovascular and cerebrovascular diseases, and the anti-diabetic drugs used by patients with diabetes. Therefore, in order to obtain appropriate standards for a patient's blood sugar control, it is necessary to understand the patient's entire condition, and it is best to follow up the patient's condition for a long time.
Relaxing sugar control standards is a kind of progress and regression
The current blood sugar standard announced by the United States shows that the diabetes academic community is getting rid of the idea of blood sugar first and blood sugar as the main focus, and is gradually moving towards comprehensive and comprehensive control of diabetes. At the same time, it has truly entered a people-oriented and data-assisted stage at the clinical operation level. . Normalization of indicators is relatively less rigid and dogmatic. What we urgently need to do now is to consider blood sugar instead of just blood sugar, and provide comprehensive management so that patients can benefit comprehensively. While treating the disease, they will also have a better quality of life and a better future. This is what we have always been doing. The real therapeutic goal that has been pursued since.