The new ADA guidelines for Type 2 state that target bs for young and motivated populations is 6.0 - 6.5, and that the target for persons with other conditions and older than 65 is 7.5 to 8.0 (average bs of 165 - 180, and to have this as an average there must be levels above 200).
Does this worry anyone else? I would think that such high targets would almost guarantee complications.
Is this something we as a community should be getting upset over and making noise over?
Hi Sally - An A1c of 7.5 to 8.0 doesn't almost guarantee complications although it certainly raises the risk. Richard posted his A1c history from 1981 to the present and he had many years above 7.5 and he has had no significant complications after more than 60 years of Type 1. I'm actually more concerned that older and unhealthy Type 2s in the United States often get almost no education, tools and support from the medical system so that irrespective of targets, they have little chance of maintaining tight control.
I saw richard's history. I think there was also some discussion that he was on animal insulins at that time, and it may have helped prevent complications (as mentioned by Gerri below).
Bernstein reckons (I listen to his telecasts) that he sees complications even for people in the 5s these days (I guess they'd be the unlucky ones with genetics against them in teh complications prevention game).
Agree that the lack of proper education, tools and support is a huge issue....
If I could change career I reckon I'd like to be invovled as an educator... but then I'm too anti-establishment and probably wouldn't get a job.
I don't think that It's even worth about getting upset over. Anyone serious about diabetes should realize by now that the ADA is a scam.
When I was a kid, my mom would sometimes buy food that had ADA endorsements. It would drive my BG way up. They don't endorse things that are good for diabetics. Any company can buy their endorsement and use their seal to sell products to diabetics.
They still do this, only the wording on the seal is changed a little.
The ADA does a very good job advocating for Food and Pharmaceutical companies. Not such a great job of advocating for people with diabetes. It's just a shame that some doctors listen to them.
But lots of innocent persons with diabetes don't realise that the ADA is a scam!
I sure didn't at the beginning. I thought they were the ones supposed to set best clinical practice, management guidelines, etc.
Many doctors, dieticians, patients etc. do follow their guidelines....
This is true. When I was a kid, my parents subscribed to their magazine. Even used their credit card for a while.
Agree with Sam. The ADA & CDA are not our advocates & never have been. ADA was against home glucose meters. Their allegiance to funding sources should be seriously questioned. However, since they unfortunately set the standards & are quoted as "the" expert, I find it cause for alarm.
Difficult to have a lower A1c following their dietary guidelines, so they promote higher A1c's. Eat more grains, take more insulin.
Gotta love the "young & motivated" term. Umm, motivated?
No one knows why some develop complications, of course, but everything should be done to lower the odds. A guideline for older diabetics that high is frightening.
My personal theory about older T1's without complications is that they used animal insulin with C-peptide.
Well, I'm 62 so I assume that older means in the late 70s or 80s. In that circumstance, a higher A1c target may be appropriate because tight control increases the frequency of lows and lows can increase fall risk which can be an almost immediate killer,
But the first generations of T1s all used animal insulin and their life expectancy was anything but good. My endo said that there was a longitudinal study at the Joslin that showed that people diagnosed in the days before NPH did better than those diagnosed later. His theory that the older regime of taking R before every meal and using rigid schedules was more effective than twice a day NPH.
ADA define older as 65 plus.
I was running low (50s) when I wrote the response above and left the smiley off the end of the first sentence. Another proof that sarcasm and irony don't work on the web.
I did use animal insulins with c-peptides for 25 years, from 1968 to 1993. Mild neuropathy( pins and needles,stiffness which comes and goes in my back, legs and feet; and improves when I am in better control)is my only complication.
I never want to have aic's pushing 8; though I daresay that I am probably around 7.5 now, due the stress and "eating southern" during my father's passing. I am working on lowering that now with low carb, higher protein and veggies, CGM use, and exercise.
I agree with you, Gerri, about the ADA. I know but a few Type 2 friends on insulin who have a1c's under 8, very few.The majority of others say their doctors tell them they are doing fine. My one Type two older woman friend(age 72) keeps her a1c in the 6's, without counting carbs and an occasional use of sliding scale, Whatever she does "works" for her.: She does check her fasting blood glucose daily and often before meals. Most of my other type 2 friends rarely check their blood sugars and are content with an 8.5, and they say their doctors are ok with that.
I do not try to be the diabetes police..I just show them how I eat when we go out or I have them in my home for dinner. They enjoy the meal choices and cannot believe they are lower carb.
Looking at the TuAnalyze "averages", most areas are running above the ADA goal ranges. That's perhaps 1) not very scientific as some are "by state" in the US/ Canada (ok, provinces...) and others are by country and there's a lot of blank space on the map but, nonetheless, we have an engaged community that, nonetheless is struggling to make their goal, being characterized here as "a scam"
Perhaps the ADA knows what the national average is and other numbers I haven't been able to track down (although I haven't looked all that hard...), it's not totally unreasonable to conclude "well they'll [us...] *never* get 5.5 so lets shoot for 6.0!" although some people are able to beat enough test strip out of our insurance companies or whatever else we do to achieve results <6. I'm inclined to agree w/ Maurie that the problem is education and a theoretical approach more than just having the goal where it is? If "140 BG" is "OK", which many Tu folks have reported being told, then a goal of 6.5 is about right? The way to fix that is to push it I think but people in generall don't like pushing things involving hard drugs like insulin?
Ok so I fall into the elder catagory according to that. My A1C is at 8.0 Funny I still like 40 years being an "elder"
Yes I think it is. Just my opinion though