Diabetes Management in Correctional Institutions

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Diabetes Care 2007 Jan; 30(suppl 1): S77-S84. https://doi.org/10.2337/dc07-S077

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Figure 1—
Essential components of the initial history and physical examination. Alb/Cr ratio, albumin-to-creatinine ratio; ALT, alanine aminotransferase; AST, aspartate aminotransferase.

Table 1—

Summary of recommendations for adults with diabetes

Glycemic control
A1C	<7.0%*
Preprandial capillary plasma glucose	90–130 mg/dl (5.0–7.2 mmol/l)
Peak postprandial capillary plasma glucose†	<180 mg/dl (<10.0 mmol/l)
Blood pressure	<130/80 mmHg

Lipids‡
LDL	<100 mg/dl (<2.6 mmol/l)
Triglycerides	<150 mg/dl (<1.7 mmol/l)
HDL	>40 mg/dl (>1.0 mmol/l)§

Key concepts in setting glycemic goals: A1C is the primary target for glycemic control Goals should be individualized Certain populations (children, pregnant women, and elderly) require special considerations More stringent glycemic goals (i.e., a normal A1C, <6%) may further reduce complications at the cost of increased risk of hypoglycemia Less intensive glycemic goals may be indicated in patients with severe or frequent hypoglycemia Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals

*
↵* Referenced to a nondiabetic range of 4.0–6.0% using a DCCT-based assay.
†
↵† Postprandial glucose measurements should be made 1–2 h after the beginning of the meal, generally peak levels in patients with diabetes.
‡
↵‡ Current NCEP/ATP III guidelines suggest that in patients with triglycerides ≥200 mg/dl, the “non-HDL cholesterol” (total cholesterol minus HDL) be utilized. The goal is ≤130 mg/dl (121).
§
↵§ For women, it has been suggested that the HDL goal be increased by 10 mg/dl.