The Standards of Care in Diabetes by the American Diabetes Association (ADA) is released every year for healthcare professionals for guidance of diabetes care.There are 17 chapters and over 300 pages on multiple topics concerning diabetes.The following is a list from the most current ADA guidelines of 2024 which people can review in order to have a conversation with your healthcare professional .

Diabetes

The criteria to define diabetes for pre diabetes in a non pregnant individual:

A1c 5.7 to 6.4% or Fasting Blood Glucose 100-125mg/dL

Criteria for diabetes in non pregnant individuals :

A1c greater or equal to 6.5%

OR

Fasting Plasma Glucose greater than or equal to 126mg/dL

OR

Oral 2 hour Plasma Glucose Tolerance test of 200 mg/gL or higher .

In an individual with classic symptoms of hyperglycemia (extreme thirst, frequent urination and unexplained weight loss) , and a random plasma glucose greater or equal to 200mg/dL can be a clear diagnosis.   However, one usually needs two of the above tests done at different times for a diagnosis.

An A1c test may not be a suitable diagnostic test for people with recent blood loss or transfusion or people undergoing hemodialysis or HIV treatment.

The American Diabetes Association suggests an A1C  goal of 7% for non pregnant adults, which is an estimated average of 154 mg/dL over a 3 month period, but glucose goals can be individualized  depending on the age or other medical issues one may have, such as limited life expectancy and/or cognitive impairments.

Recommendations for many non pregnant adults with diabetes from the ADA:

A1c less than 7%

Pre meal blood glucose: 80-130 mg/dL

Peak post meal glucose (taken 1-2 hours after the beginning of the meal ):less than 180mg/dL.

Hypertension ( High Blood Pressure)

Hypertension is common among people with either type 1 or type 2 diabetes.

Blood pressure has two numbers:systolic and diastolic.Blood pressure should be checked at every routine clinical visit. Hypertension is defined as a systolic blood pressure greater than or equal to 130mmHg or a diastolic blood pressure greater than or equal to 80mmHg .In order to be diagnosed, the readings should be an average of two or more measurements on two or more occasions.

For people with diabetes and hypertension, blood pressure goals should be individualized with the healthcare provider to address the cardiovascular risks and need for medications.

Lipid Profile

Atherosclerotic cardiovascular disease is the leading cause of death for people with diabetes. Hypertension and abnormal lipids are risk factors for heart attack and stroke.People with diabetes are prone to cholesterol problems and suffer from clogging of the arteries that deliver blood to the heart, brain and lungs.

In adults with pre diabetes or diabetes, a lipid lab panel for total cholesterol, LDL (lousy) cholesterol ,HDL( good) cholesterol and triglycerides are reasonable to obtain at the time of diagnosis and and annually thereafter or more frequently if indicated . The lipid profile test should be done after fasting ( nothing to eat after midnight with blood drawn first thing in the morning before eating),in order to get an accurate result .

LDL Cholesterol goal for people with diabetes without heart disease is less than 70mg/dL and  less than 55mg/dL for those with diabetes and heart disease.

Triglyceride goal is less than 150mg/dL.

HDL Cholesterol goal is greater than 35 mg/dL.

Once a person is started on statin medication to lower cholesterol , LDL cholesterol levels should be checked every 4-12 weeks after initiated, after any change in dose and annually.

Kidney Function

Diabetes kidney disease takes years to develop and to deteriorate   into a severe situation.In early stages of kidney disease, there are no symptoms.It is very important to screen for kidney disease.

Urine Screening for microalbuminuria ( small amounts of protein in the urine) for Type 1 Diabetes is once a year beginning 5 years from the time of diagnosis. People with  Type 2 should be screened every year from the time of diagnosis. A random sample of urine can be used for the albumin-to-creatinine ratio (UACR).The normal UACR is <30 mg/g Cr.

Another test to measure the kidney function is Estimated Glomerular Filtration Rate( eGFR). This is a non-fasting blood test. This should be done once a year. A normal eGFR is >90mLmin/1.73m. 60-90 may suggest mild kidney disease.

The information provided can help start a conversation with one’s Health Care Provider once diagnosed with pre diabetes or diabetes. One can live a long and healthy life by completing the screening for diabetes, high blood pressure, high lipids and kidney disease. Learn ways to prevent complications like a heart attack or stroke from one’s HCP and/or Diabetes Care and Education Specialist.

About the author:
Dianna Morrow is a certified Diabetes Care and Education Specialist and Registered Nurse at Encompass Health Rehabilitation Hospital of York, Pennsylvania. Dianna is a co-facilitator of the Diabetes Protocol team at Encompass Health. She is also a member of the York County Diabetes Coalition in York, PA.