The ABC goals in diabetes to prevent complications

Professor Dr Moy Foong Ming, Professor Dr Noran Naqiah Hairi and Dr Wan Kim Sui (our Doctor of Public Health candidate) wrote to the media to raise awareness about the ABC goals in diabetes to prevent complications, which has been published in The Star.

About one in every five Malaysian adults have diabetes, which translates to a staggering 3.9 million people. The economic cost of diabetes is enormous. The conservative estimate of diabetes was RM10.2 billion in 2017, equivalent to 0.7% of Malaysia’s gross domestic product in that year alone.

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. 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 general goal is <140/80 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 <1.4 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. The proportion of patients achieving all ABC goals were under 10% in most parts of the world. In Malaysia, only 5.8% of our diabetes patients attained all their ABC goals.

Some recommendations for people with diabetes are:

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 bodyweights (if overweight/obese), and stop smoking.
4. Practice diabetes self-care such as monitoring blood sugar at home and checking your foot regularly

*The values have been updated to reflect the latest Malaysian clinical recommendations.