American Diabetes Association
is recommending changes in blood pressure goals for people with diabetes and
clarifying how frequently people with type 1 diabetes should test their blood
The revised recommendations include raising the treatment goal for high
blood pressure from <130 mm Hg to <140 mm Hg, based on several new
meta-analyses showing there is little additional benefit to achieving the lower
targets. Clinical trials have demonstrated health benefits to achieving a goal
of <140 mm Hg, such as reducing cardiovascular events, stroke, or
nephropathy, but limited benefit to more intensive blood
pressure treatment, with no significant reduction in mortality or nonfatal
heart attacks. There is a small but statistically significant benefit in terms
of reducing risk of stroke, but at the expense of a need for more medications
and higher rates of side effects.
The new standards also clarify when people who are taking multiple daily
doses of insulin (MDI) or using insulin pumps, typically those who have type 1
diabetes, should test their blood glucose levels. Previously, the standards
called for those taking insulin to test "3 or more" times throughout
the day, a recommendation that was sometimes misinterpreted to mean that 3
times per day was sufficient. Recognizing that the frequency of testing will
differ by individual and by situation, the new standards do not specify the
number of times that testing should occur but instead focus on the conditions
under which testing should occur. For example, the standards now specify that
patients on MDI or insulin pumps should test prior to meals and snacks,
occasionally after eating, at bedtime, before exercise, when they suspect low
blood glucose, after treating low blood glucose levels until they return to
normal, and "prior to critical tasks such as driving."
Additionally, the new standards highlight that for patients on less
intensive regimens or noninsulin therapies, self-monitoring of blood glucose
needs to be linked to educating the patient about how to use the information
about glucose levels appropriately. These patients must also be educated about
how frequently they need to test and under what conditions.
The new guidelines will be published in a special supplement to the January
issue of Diabetes Care as part of the
association's revised Standards of Medical Care, which are updated annually to
provide the best possible guidance to health care professionals for diagnosing
and treating adults and children with all types of diabetes. The standards are
based upon the most current scientific evidence, which is reviewed by the
association's multidisciplinary Professional Practice Committee.
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