Posts Tagged ‘target A1c levels’

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Youth with T1 Diabetes Not Meeting A1c Targets: What Can Nurses Do?

February 13, 2013

By Jeniece Trast, MA, RN, CDE, clinical research nurse manager, certified diabetes educator, Children’s Hospital at Montefiore, Montefiore Medical Center, Bronx, NY

bloodglucosetestingDiabetes Care recently published an article showing that our youth with type 1 diabetes, especially those in adolescence, are not meeting glycosylated hemoglobin (HbA1c) clinical guidelines. The HbA1c is a blood test done every two to three months that shows how well controlled the glucose levels were over that time period. As much as this news is disappointing, I am not shocked by it. Type 1 diabetes is a challenging disease to live with at any age; however, the adolescent years definitely intensify the challenge.

As a nurse and certified diabetes educator (CDE), I take on many roles when caring for a teenager with type 1 diabetes: educator, team member, moderator, blood glucose assessor, advocate, cheerleader, and even role model (yes, I have type 1 diabetes also).

Challenges and responsibilities. When caring for these patients, keep in mind that type 1 diabetes is a difficult disease to live with on a day-to-day basis. People with type 1 have lots of important responsibilities just to stay alive: multiple insulin administrations each day; constant blood glucose checking; understanding the effects of exercise on glucose level both during and after exercise; balancing exercise, stress, food, and insulin; providing sick day care; assessing for and treating hypoglycemia; troubleshooting when things go wrong; carrying supplies at all times; and worrying about the disease’s future possible complications—just to name of few!

Particular stresses for teens. These obligations require education, clinical and psychological support, and motivation. Nurses can play a vital role in all of that. Additionally, teenagers want to feel “normal,” puberty occurs, growth spurts happen, peer pressures influence them, erratic lifestyles dictate their lives, they long for independence, and many other potentially difficult situations occur during adolescence. All of this contributes to the fact that these teens are not achieving optimal control.

What can nurses do? There are many things we can do with our teenage patients to help them achieve both their goals and our goals. Read the rest of this entry ?

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Individualized A1c Targets for Type 2 Diabetes

October 23, 2012

By Jane Seley, DNP, MPH, MSN, BC-ADM, CDE, diabetes nurse practitioner at New York Presbyterian/Weill Cornell Hospital, New York City

On April 19th, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) released a joint position statement online that represented a giant step forward in the care of people with type 2 diabetes. “Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach” is a comprehensive yet easy to read primer in the most up-to-date therapies, one that also emphasizes individualizing care as the key to success.

An example of the patient-centered approach of this position statement is a refinement of the customary across-the-board hemoglobin A1c test target recommendation of less than 7% for most people with type 2 diabetes, with pre-meal blood glucose (BG) targets of less than 130 mg/dL and post-meal targets of less than 180 mg/dL. The position statement suggests “more stringent” targets of 6%–6.5% for “selected” patients who are younger and in good health, but safer targets of 7.5%–8% for older patients who have comorbidities or are prone to hypoglycemia.

When discussing therapeutic options, each medication is ranked according to its potential for lowering A1c, risk of hypoglycemia, effect on weight, adverse effects, and cost. In addition, the clinician is encouraged to individualize the treatment regimen by considering age, weight goal, and comorbidities such as heart disease and kidney function. For example, if losing weight is an important consideration for the patient, then a medication that may assist in weight loss such as metformin (oral agent) or a GLP-1 receptor agonist (injectable) would be good choices. A weight-neutral alternative would be a DPP-IV inhibitor (oral agent).

The position statement reminds us that lifestyle changes are a priority, with a focus on weight optimization, healthy meals, and increased activity levels. My favorite part of this document is the recommendation that treatment decisions be made in partnership with the patient, with a focus on each individual’s preferences, needs, and values.

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