Experts recommend a more personal approach to type 2 diabetes

Howard LeWine, M.D.

Chief Medical Editor, Harvard Health Publishing

For many people with types 2 diabetes, and their doctors, managing this vexing condition has been all about the numbers. One number, to be precise: the hemoglobin A1c reading. It’s a measure of the average blood sugar level over the preceding three months. New guidelines from the American Diabetes Association (ADA) and European Association for the Study of Diabetes recommend taking a more “patient-centered approach” to managing type 2 diabetes.

Type 2 diabetes occurs when a person’s muscle cells stop responding to insulin, a hormone made by the pancreas. You can think of insulin as a tiny molecular key that opens the door through which glucose (blood sugar) flows into cells. When muscle cells resist insulin’s “open up” signal, glucose builds up in the bloodstream. Over time, this harms tissues throughout the body, from the brain to the toes. It can damage nerves, rob vision, and cause heart disease.

A simple way to check blood sugar is to measure the percentage of hemoglobin molecules (the oxygen-carrying protein in red blood cells) that have become coated with glucose. This is known as the hemoglobin A1c (HbA1c) test. The higher the average daily blood sugar over a three-month period, the higher the HbA1c value.

People who don’t have diabetes have HbA1C readings below 5.7%. For years, the American Diabetes Association recommended that almost everyone with type 2 diabetes should aim for an HbA1c level less than 7%. Keeping blood sugar as low as possible, called “tight control,” was thought to limit the havoc caused by diabetes.

But a series of studies have shown that tight control for people who have had diabetes for many years doesn’t improve quality of life or longevity. And for some people, trying to keep blood sugar low enough to hit the HbA1C target of 7% or lower means experiencing episodes of low blood sugar (hypoglycemia). Hypoglycemia can cause blackouts, seizures and strokes. In older people, frequent bouts of low blood sugar can worsen brain function.

One size doesn’t fit all

The new guidelines acknowledge that people are different. TheADAnow recommends that individuals and their doctors decide together on a blood sugar target.

For people who are newly diagnosed with type 2 diabetes but who are otherwise in good health, the ADA still suggests aiming for tight control. For them, an HbA1C of 6.0% to 6.5% is ideal. This is especially true if the goal can be met with lifestyle changes only (such as losing weight and exercising more), or with lifestyle plus the medication metformin (generic, Glucophage, Fortamet).

For people who have had diabetes for a while, an HbA1c goal of 7.5% to 8.0%, or even higher, may be more appropriate. Reasons for “looser” blood sugar control include:

  • Older age
  • Frequent bouts of hypoglycemia
  • The presence of other medical conditions requiring multiple medicines and needing more than 2 drugs to lower blood sugars
  • Limited financial resources

Controlling blood sugar is only one part of managing type 2 diabetes to limit its effects on health. Controlling weight and blood pressure are very important, as are efforts to prevent heart disease, stroke, and kidney disease, all of which can occur as a result of diabetes.

These new patient-centered recommendations are a breath of fresh air. They will be good for people with type2 diabetes and for their doctors. Patient-centered care should be main theme of all health guidelines.

Related Information: Healthy Eating for Type 2 Diabetes


  1. Anonymous

    I remember some of my acquaintances have diabetes, but most of them do not know what to do to survive and recover. All diabetes sufferers definitely like to recover. Perhaps, the most needed is the knowledge of diabetes which can be reached by all segments of society. I strongly agree that a healthy lifestyle is the key. So, let’s start a healthy life from now on.

  2. Mike

    I have just written up an article regarding type 1 diabetes in children and how parents aren’t promoting healthy living, eating and excercise is meaning that we are seeing a rise in type 2 diabetes in children even more now! To see this rise in type 2 diabetes in young children is very serious considering a few years ago it was generally unheard of!

  3. drh

    Do something good for everyone, adopt a dog.
    • Dog owners exercise more, more consistently and walk faster while exercising.
    • Dog owners that regularly exercise their dogs have one third the risk of diabetes than people that do not walk their dog according to Cindy Lentino.
    • Dog owners generally require ~20 less medications than non-dog owners.

    There are thousands of dogs in shelters and rescue groups that need someone to save their life.

    Save a life that may help save yours, adopt a dog.

  4. lucky

    Part of the problem also is that many women stay away from lifting weights because they fear looking too muscular (so something like that!). But it is the perfect exercise because it adds the lean muscle tissue and increases the baseline metabolism.

  5. Lynn Maarouf

    I think that one of the biggest problems we face right now is not being able to start diabetes eduction early enough. If we really want to decrease long term complications and mortlity we need to have coverage from the Prediabetes stage. Many people are intereted in doing something about diabetes before it gets started. Why in this country of so much $$$ do we always have to wait until insurance decides to pay for things ?

  6. tavy

    I read on a website about these plants that would be good for diabetes: Mirtyllina
    Black Mulberry
    Is this true?

  7. Christina Sponias

    I believe that controlling weight is as hard as controlling blood sugar. I hope that those who suffer from diabetes 2 will manage to follow the necessary steps for their recovery.

  8. Gretchen

    Subgroup analysis of the Accord study showed that the people with higher mortality were those who attempted to reach the lower A1c with a bunch of drugs *but didn’t succeed.* Those who actually reached the lower target had lower mortality.

    But because of this, GPs are telling their older patients to get their A1c higher, even if those patients are getting A1cs in the 5s with diet alone and no lows.

    Remember the first principle: Do no harm. Misinterpretation of Accord is causing harm.

  9. nando eriawan

    is it true that diabetes 2 still can’t to be cured? I read in some blogs and articles and they said so. just the preventive action is there, I hope there’s a medical treatment that can cure those have got diabetes-2.

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