The American Diabetes Association (ADA) has raised the recommended treatment goal for systolic high BP from <130 mm Hg to <140 (with a diastolic goal of <80) in its annual update to “Standards of Medical Care—Diabetes.”
The change to the BP goals were made based on several new meta-analyses showing little additional benefit to achieving the lower targets. Although clinical trials have demonstrated health benefits to achieving a goal of <140, such as reducing cardiovascular events, stroke, or nephropathy, more intensive BP treatment has shown limited benefit with no significant reduction in mortality or nonfatal heart attacks.
Tighter BP control does slightly reduce stroke risk, but that benefit might be offset by the need for more medications to control BP and higher rates of side effects.
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“Raising the recommended [BP] target, however, is not meant to downplay the importance of treating high [BP] in people with diabetes…nor should this be taken to mean that lower target rates are inappropriate,” cautioned the ADA in a statement.
Another guideline change involves the frequency of self-monitoring of blood glucose (SMBG) for persons who take multiple daily doses of insulin or use an insulin pump.
Whereas the ADA had previously recommended that such patients engage in SMBG “three or more” times throughout the day, the organization now urges them to test their blood glucose based on certain activities: prior to meals and snacks, occasionally after eating, at bedtime, prior to exercise, prior to driving and other critical tasks, when low blood glucose is suspected, and after treating low blood glucose.
“Many patients will need to test six to eight times per day, but some will need to test more, depending on their activity level, how often they eat, and what other types of activities their day may include,” explained the ADA statement. “It is not reasonable or practical to set a specific number for all people with diabetes who are on intensive insulin regimens, as no two people’s lives are the same [and] no two days are exactly alike.”
Persons on less intensive insulin regimens or noninsulin therapies require ongoing education as to how frequently they need to participate in SMBG and how to adjust food intake, exercise, or medications to achieve specific blood glucose goals.
