At the moment, the concepts of “compensation” and “decompensation” of diabetes have left the professional lexicon of endocrinologists. Now for each patient, individual goals of diabetes mellitus therapy are determined.
The key indicator when choosing an individual treatment goal for diabetes is the target level of glycated hemoglobin (HbA1c). This is the patient’s integrated (average) blood glucose reading for the last 3 months.
The main goal in diabetes therapy is the rapid achievement and long-term maintenance of blood glucose levels within the individual target values to prevent the development of vascular complications. The individual target level of glycated hemoglobin is different for each patient and depends on:
- age,
- concomitant atherosclerotic cardiovascular diseases (CAD),
- a tendency to severe hypoglycemia (a sharp decrease in blood sugar).
Significant concomitant atherosclerotic cardiovascular diseases are myocardial infarction, coronary artery bypass grafting or stenting, angina pectoris, cerebrovascular accident (stroke). In these situations, a sharp drop in blood glucose or a tendency towards low-normal blood glucose levels is especially unfavorable.
For a healthy person, normal values are glycated hemoglobin (HbA1c) — from 4.0 to 6.0% and fasting blood glucose (venous plasma) — less than 6.1 mmol / l.
For patients with diabetes mellitus without concomitant ASCVD, depending on age, the target HbA1c level can range from 6.5% to 7.5%.
In the presence of concomitant severe ASCVD, low blood glucose levels are more dangerous for the patient than high ones. In this situation, an individual target HbA1c level of 7.5% and above is set for him.
If the target glycemic indicators are reached, the prescribed treatment is considered adequate. The patient is advised to continue the selected therapy and be regularly monitored by a therapist. If there is a need to adjust the treatment, the patient is sent for a consultation with an endocrinologist again.