Why The Higher Blood Sugar Targets for Type 1 diabetes?

Your thoughts and feedback!

The American Diabetes Association (ADA) publishes the Standard of Medical Care in Diabetes, a comprehensive guide intended for clinicians, researchers, policymakers, and individuals interested in various components of diabetes care. Similar documents are released by diabetes associations worldwide, contributing to the collective knowledge in diabetes management.

➡️ American Diabetes Association Clinical Glycemic Targets for Adults with Type 1 diabetes

In their 2023 edition, the ADA outlines clinical glycemic targets for adults with Type 1 diabetes. On page S101, they provide three recommendations for A1C targets for non-pregnant adults (primary recommendation first):

A1C <7%
A1C <8%

*On the basis of health care professional judgement and patient preference, A1C levels lower than the goal of 7% may be acceptable.

➡️ American Diabetes Association Clinical Glycemic Targets for Children and Adolescents with Type 1 diabetes

For children and adolescents, the ADA offers four recommendations for A1C targets on page S236 (primary recommendation first):

A1C <7%
A1C <7.5%
A1C <8%
A1C <6.5% (may reasonably suggest more stringent A1C goals for select individuals)

➡️ Estimated Average Blood Glucose at Corresponding A1C

A valuable table on page S98 illustrates the Estimated Average Blood Glucose (eAG) corresponding to each A1C level:

A1C – 5% - estimated Average Blood Glucose – 97mg/dl or 5.4mmol/l
A1C – 6% - 126mg/dl or 7.0 mmol/l
A1C – 7% - 154mg/dl or 8.6mmol/l
A1C – 8% - 183mg/dl or 10.2mmol/l
A1C – 9% - 212mg/dl or 11.8mmol/l
A1C – 10% - 240mg/dl or 13.4mmol/l

➡️ Goals of Type 1 diabetes Management

The Diabetes Teaching Center at UCSF emphasizes two primary goals of Type 1 diabetes management:

1️⃣ To maintain blood sugar as normal as possible without serious highs or lows.
2️⃣ To prevent tissue damage caused by excessive sugar in the bloodstream.

Optimal glycemic control, maintaining blood sugars within the normal range, is crucial to reduce the risk of hypoglycemia and diabetic complications.

➡️ What are Normal, Non-Diabetic Blood Glucose Levels?

According to the WHO, fasting blood glucose levels in healthy individuals range between 70 mg/dL (3.9 mmol/L) and 100 mg/dL (5.6 mmol/L).

And according to Röder, Wu, Liu & Han, the pancreas strives to keep blood sugar within the narrow range of 4–6 mm (72-108mg/dl), ensuring optimal health.

➡️So, Why The Higher Clinical Glycemic Targets

Considering the body's natural aim to maintain blood glucose between 4.0 – 6.0mmol/l (72mg/dl – 108mg/dl) for optimal health, and the groundbreaking Diabetes Control and Complications Trial (DCCT) study concluding that intensive therapy targeting glycemic levels as close to non-diabetic range as safely possible significantly reduces diabetes complications, it raises questions.

Why does the ADA recommend an A1C target of <7%, equivalent to an average blood sugar level of 154mg/dl or 8.6mmol/l, approximately 71% higher than a blood glucose level of 90mg/dl or 5.0mmol/l, which is right in the middle of the normal blood glucose range?

I’d love your input!

Stay tuned for my follow-up post, where I’ll delve into my thoughts and explore the clinical guidelines to understand why recommendations are significantly higher than what the body naturally seeks for optimal health.

If you are interested in implementing a Therapeutic Carbohydrate Reduction/Low-carb nutrition strategy so you can safely achieve normal blood sugar levels, please don't hesitate to visit:

🖱 https://www.t1dnutrition.com/
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P.S.: here is two images of last night’s Therapeutic Carbohydrate Reduction/Low-carb dinner!
Grilled chicken thighs marinated in lime juice, extra virgin olive oil, cilantro, cumin, and garlic, served with a Greek salad, with extra virgin olive oil and balsamic vinegar dressing, and boiled cauliflower with butter and salt! Total time to table -> 25mins

Foods high in essential nutrients, and low in their impact on blood glucose levels!

REFERENCES

Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, Dennis Bruemmer, Billy S. Collins, Marisa E. Hilliard, Diana Isaacs, Eric L. Johnson, Scott Kahan, Kamlesh Khunti, Jose Leon, Sarah K. Lyons, Mary Lou Perry, Priya Prahalad, Richard E. Pratley, Jane Jeffrie Seley, Robert C. Stanton, Robert A. Gabbay; on behalf of the American Diabetes Association, 6. Glycemic Targets: Standards of Care in Diabetes—2023. Diabetes Care 1 January 2023; 46 (Supplement_1): S97–S110. https://doi.org/10.2337/dc23-S006

Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, Dennis Bruemmer, Billy S. Collins, Marisa E. Hilliard, Diana Isaacs, Eric L. Johnson, Scott Kahan, Kamlesh Khunti, Jose Leon, Sarah K. Lyons, Mary Lou Perry, Priya Prahalad, Richard E. Pratley, Jane Jeffrie Seley, Robert C. Stanton, Robert A. Gabbay; on behalf of the American Diabetes Association, 14. Children and Adolescents: Standards of Care in Diabetes—2023. Diabetes Care 1 January 2023; 46 (Supplement_1): S230–S253. https://doi.org/10.2337/dc23-S014

Röder, P. V., Wu, B., Liu, Y., & Han, W. (2016). Pancreatic regulation of glucose homeostasis. Experimental & molecular medicine, 48(3), e219. https://doi.org/10.1038/emm.2016.6 WHO: World Health Organization (2023). Mean fasting blood glucose. In The Global Health Observatory. https://www.who.int/.../indicator.../imr-details/2380

Diabetes Teaching Center at the University of California, San Francisco: https://dtc.ucsf.edu/.../monitoring.../goals-of-treatment/)

Summary of the DCCT/EDIC study - national center for biotechnology ... (n.d.). https://www.ncbi.nlm.nih.gov/.../gap/cgi-bin/GetPdf.cgi...