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New ADA Guidelines Revise Blood Pressure Goals, Testing Frequencies

The American Diabetes Association’s newly released 2013 edition of its annual “Standards of Medical Care in Diabetes” recommends two notable changes:

  1. A recommendation that diabetes patients have their blood pressure tested during every routine visit to their healthcare providers and that the target treatment goal for high blood pressure be revised from <130 mm Hg to <140 mm Hg.
  2. A change in the frequency the ADA recommends that people with type 1 diabetes test their blood glucose levels from “three or more times” per day to event-specific times that may call for much more testing. Among the times that type 1s may want to test, which can number six, or eight, or even more times per day include:
    1. Before meals and snacks
    2. Occasionally after meals
    3. At bedtime
    4. Before exercise
    5. When patients suspect low blood glucose
    6. After treatment for low blood glucose until patients are normoglycemic
    7. Before critical tasks such as driving

An ADA spokesman said that raising the recommended blood pressure target goal is not meant to downplay the importance of treating high blood pressure in people with diabetes. “Untreated hypertension can be very dangerous,” said Richard Grant, MD, MPH, incoming chair of the ADA Professional Practice Committee and research scientist at Kaiser Permanente Division of Research. 

“Nor should this be taken to mean that lower target rates are inappropriate. They may be appropriate for some patients, particularly those who are younger and have a longer life expectancy, or for those who have a higher risk of stroke—if the lower goal can be achieved without excessive amounts of treatment and without a heavy burden of side effects from medication.”

Regarding the recommended blood glucose testing changes, Carol Wysham, MD, outgoing chair of the ADA’s Professional Practice Committee and section head for the Rockwood Center for Diabetes and Endocrinology, said “Many patients will need to test six to eight times per day, but some will need to test more, depending upon their activity level, how often they eat, and what other types of activities their day may include. 

“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 person’s lives are the same. Even for the same individual, no two days are exactly alike. A person may need to test six times one day and 10 the next.”

The full clinical practice recommendations have been published in the January issue of Diabetes Care.

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