The 2020 ADA Standard Six, reviews Glycemic Targets. Two things caught my eye in this section:

1. The updated estimated Average Glucose (eAG) chart not only shows the relationship to A1c and eAG, it also shows the range of glucose for any of the given A1c values. This extra data will certainly be helpful as we discuss the significance and meaning of A1c results with participants.
2. Also, for participants utilizing CGM technology, this standard recommends that providers of diabetes care review the Ambulatory Glucose Profile (AGP) report each visit.

Ambulatory Glucose Profile (AGP) Report benefits: Since the A1C does not provide a measure of glycemic variability or hypoglycemia, the AGP is especially helpful for those prone to bigger glycemic swings.

Glycemic management is best evaluated by the combination of results from SMBG or CGM and A1C. A review of the AGP Report is recommended at each visit for those using CGM technology.

The overall goal is to reach Time in Target Range (70-180) at least 70% percent of the time with minimal hypo and hyperglycemia. In this snapshot ADP Report example below, we see that the A1c is 7.6%, but when we look at the right hand Time in Range side, we quickly note that this individual is struggling with frequent lows and very low glucose levels coupled with hyperglycemia. The time is range is only 47%.

This data is invaluable to help start the process of problem solving to decrease hypo and hyperglycemic events and increase time in target.

An A1c by itself, even if accompanied with frequent blood sugar checks, may not capture this complete picture of 24 hour glucose variability.

See our blog on Time in Range for more info about targets for different groups.

Those are just some of the highlights of the 2020 Standards of Care. Please join Coach Beverly on January 21st at 11:30 for her annual State of the Standards Live Webinar.

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