According to Dr. Vivian Fonseca, president of medicine and science for the American Diabetes Association, the management of type 2 diabetes is ‘making a lot of progress’ with these new guidelines: ‘The new guidelines are more patient-centred. The message is to choose an appropriate [blood sugar] goal based on the patient’s current health status, motivation level, resources and complications.’
Fonseca continued, ‘It is very possible to manage type 2 diabetes well and keep blood sugar under good control’ but in order to do so, ‘It’s important that patients have a discussion with their doctor about what their [blood sugar] goals should be, and what is the best treatment or treatments to get them to that goal’ because the management of type 2 diabetes is becoming increasingly complex. According to Fonseca, there is a expanding collection of medications available to treat the disease, and the pros and cons of these treatments are always being explored and highlighted by new research studies.
Clearly, the patient-centred approach is the biggest change in the new guidelines, with good reason. Previously, most people with type 2 diabetes have been recommended to lower their haemoglobin A1C levels (HbA1C), which is a measure of long-term blood sugar control, by 7%, but the new guidelines suggest that more stringent goals of 6-6.5% could might be appropriate for someone who has a long life expectancy, no history of heart disease and who hasn’t experienced significant low blood sugar levels or hypoglycaemia. This works in the same way on the other end of the scale, as the guidelines note that blood sugar targets should be looser (7.5-8% A1C) for people who are older than 65 or 70, as they more at risk of side effects from taking multiple medications.
However, what hasn’t changed in the guidelines is the importance of making lifestyle changes, and the recommendations are to lose 5-10% of body weight, and to participate in modest exercise for at least two-and-a-half hours each week.