The ABC goals in diabetes to prevent complications

We read the news article entitled “Diabetes on the rise among Malaysians” (Nov 15, 2020) with great concern about our ailing nation and potentially avoidable complications.

About one in every five Malaysian adults has diabetes, which translates to a staggering 3.9 million people.

The economic cost of diabetes is enormous. The conservative estimate of diabetes was RM10.2bil in 2017, equivalent to 0.7% of Malaysia’s gross domestic product in that year alone.

This has not accounted for the health and economic impacts of diabetes complications, such as cardiovascular diseases (heart attack and stroke).

Many of these complications can actually be prevented by having good control of A1C, blood pressure, and LDL-cholesterol – also known as the “ABC” goals.

What are ABC goals?

A = A1C is glycosylated haemoglobin. A1C reflects the average blood sugar level over the past three months. Last-minute effort of eating "clean", adhering to medication and exercise will not alter the A1C results.

A1C goal of 6.0–6.5% is advocated for patients with a shorter duration of diabetes, younger age, and those with minimal risk of low blood sugar (hypoglycaemia). A less tight A1C goal of 7.1–8.0% may be appropriate for patients who are prone to low blood sugar and have advanced complications or comorbidities. Others can aim for an A1C goal of 6.6–7.0%.

B = Blood pressure is expressed as a measurement with two numbers, with one value at the top (systolic) and one on the bottom (diastolic). The goal is ≤135/75 mm/Hg.

C = Cholesterol. The "bad" type (known as LDL-cholesterol) is often the one associated with cardiovascular complications. The goal is ≤2.6 mmol/L for most of us. In those with heart disease or stroke, the goal is <1.8 mmol/L.

Reducing A1C by 0·9%, systolic blood pressure by 10 mm Hg, or LDL-cholesterol by 1 mmol/L can each reduce the risk of cardiovascular disease and death, by 10–20%.

The benefits of achieving more ABC treatment goals are incremental. The more goals achieved, the better the outcomes in preventing diabetes complications.

What can people with diabetes do?

1. Be aware of the importance of ABC control. Know your ABC values, monitor them, and try to achieve your treatment goals.
2. Adhere to your treatment plan. If your doctor thinks there is a need to modify current therapy, be more receptive to it.
3. Eat sensibly, exercise regularly, reduce body weight (if overweight/obese), and stop smoking.
4. Practise diabetes self-care such as monitoring blood sugar at home and checking your foot regularly

It is important for people with diabetes to realise that they can prevent complications by paying more attention and efforts to control their ABC goals.

PROF DR MOY FOONG MING, PROF DR NORAN N HAIRI and DR WAN KIM SUI

Centre for Epidemiology and Evidence-Based Practice

Department of Social and Preventive Medicine

Faculty of Medicine, University of Malaya