Treatment for diabetes needs to be planned on an individual level, in which the characteristics and social circumstances of each patient are taken into account.
The therapeutic goals should also be adapted for each patient. The risks and benefits of each therapeutic act should be weighed, in addition to the ability of the patient to comply with the treatment.
Large population studies have contributed to knowledge regarding the medium and long-term consequences of diabetes. These results have made it possible to establish general treatment objectives for the population.
The main goal is to ensure a sufficiently controlled mean blood glucose value, so as to reduce the possibility for complications from the disease. The mean blood glucose value is determined by a laboratory parameter, glycosylated hemoglobin or A1c – whose normal maximum value is near 6.0% (in most laboratories).
Based on this parameter, scientific societies have defined the following control objectives, namely mean blood glucose values above the normal limits:
- The European Association for the Study of Diabetes has defined a value equal to or below 6.5%, in the absence of hypoglycemia.
- The American Diabetes Association has defined the value of 7.0%, in the absence of hypoglycemia.
- Both societies believe that the treatment goals should be less ambitious for individuals with a serious associated disease, for those people at an advanced age or whose condition has evolved over a long period of time with difficulties in attaining the aforementioned objectives. In these individuals, the goal is to obtain the best level of control possible rather than working towards perfectly defined objectives.
The aforementioned aims convey the difficulty in obtaining highly controlled values and the need to prevent very low values. In fact, while attempting to control the values, there is a risk of causing hypoglycemia, which can result in very harmful outcomes.
It is equally important to control other associated cardiovascular risk factors by:
- Smoking cessation
- High blood pressure control
- Cholesterol levels control
- Use of platelet anti-aggregates in individuals with a high cardiovascular risk