From the Guidelines
You are doing a great job managing your diabetes, and your current A1c level of 6.1% is below the recommended target range of 7% to 8% for most adults with type 2 diabetes, as suggested by the American College of Physicians guidance statement 1. To maintain good glycemic control and minimize the risk of complications, it's essential to continue your current management approach, including any prescribed medications, regular physical activity, healthy eating habits, and consistent blood glucose monitoring. Some key points to consider:
- The American College of Physicians recommends aiming for an HbA1c level between 7% and 8% in most patients with type 2 diabetes, as this range balances the benefits and harms of glycemic control 1.
- More intensive glycemic control, targeting HbA1c levels below 6.5%, has not been shown to provide significant clinical benefits and may increase the risk of hypoglycemia and other adverse effects 1.
- It's crucial to personalize glycemic goals based on individual patient characteristics, such as life expectancy, comorbid conditions, and risk for hypoglycemia, as well as patient preferences and values 1.
- Regular monitoring and adjustments to your treatment plan, as needed, will help ensure that you continue to achieve good glycemic control and minimize the risk of diabetes-related complications.
From the Research
Patient Information
- For a patient with diabetes and an A1c level of 6.1, it is essential to consider the implications of this value in the context of their overall health and treatment plan.
- The patient's A1c level is slightly above the target range, and according to the study 2, an A1c cutoff of 5.9% is suggested for identifying undiagnosed diabetes, while an A1c level of 5.6% or higher may indicate an increased risk for future diabetes.
Treatment Considerations
- The study 3 suggests that supplementation of metformin with liraglutide and then insulin detemir can be well-tolerated in patients with type 2 diabetes, resulting in good glycemic control and sustained weight loss.
- Another study 4 found that dual inhibition of SGLT1 and SGLT2 with LX4211 produced significant dose-ranging improvements in glucose control without increasing glucosuria, and was associated with reductions in weight and systolic blood pressure.
- Additionally, the study 5 suggests that lowering the hemoglobin A1c level to less than 6.0% in people with type 2 diabetes may reduce major adverse cardiovascular events, although this is still a topic of debate.
Patient Communication
- You can tell the patient that their A1c level is slightly elevated, and that this may indicate a need for adjustments to their treatment plan to reduce their risk of cardiovascular events and other complications associated with diabetes.
- It is also important to discuss the potential benefits and risks of different treatment options, such as intensifying their metformin treatment or adding other medications, and to work together to develop a plan that takes into account their individual needs and health goals, as suggested by studies 3, 4, and 5.