Three Glycemic Control Goals: Liberal, General, and Strict

Which goal is suitable for you? Have you achieved your goal? Keep these questions in mind while attending this lecture, and you are sure to gain valuable insights.

The core purpose of this approach is to help each of you learn to evaluate the effectiveness of your glycemic control. For instance, if you have been taking medication or insulin for a long time, you must have a clear benchmark in mind to assess whether your blood glucose levels are ideally controlled. It is essential to learn how to evaluate and judge. In this lesson, we will first discuss two concepts: diagnostic criteria and treatment targets. In daily practice, I have found that many people confuse these two, mistakenly using diagnostic criteria as treatment targets. As we have mentioned before, normal blood glucose levels should not exceed 6.1 mmol/L fasting or 7.8 mmol/L postprandial. However, many people treat 6.1 and 7.8 as their treatment goals, leading to severe hypoglycemia, poor glycemic control, and physical discomfort.

This lesson aims to help you resolve this issue. First and foremost, diagnostic criteria and treatment targets are not the same. You must understand this distinction clearly and unequivocally. Otherwise, your treatment will be aimless and ineffective. Without clear goals or standards, how can you judge whether your blood glucose control is good or not?

Diagnostic criteria determine whether you have diabetes. They address the nature of your condition—whether you are normal, prediabetic, or diabetic. Treatment targets, on the other hand, define the extent to which your blood glucose should be controlled. For example, how well your blood glucose is managed and what level is most suitable for you after being diagnosed with diabetes fall under the scope of treatment targets. These are two entirely different matters. For normal individuals, fasting blood glucose ranges from 3.9 to 6.1 mmol/L, and two-hour postprandial blood glucose ranges from 3.9 to 7.8 mmol/L. For prediabetic patients, fasting blood glucose ranges from 6.1 to 7.0 mmol/L, and two-hour postprandial blood glucose ranges from 7.8 to 11.1 mmol/L.

I have interviewed over 100 diabetic patients and asked them what the optimal fasting blood glucose level should be. Almost all of them believed it should be below 6.1 mmol/L. This is a classic example of mistaking diagnostic criteria for treatment targets—a dangerous misconception. Therefore, it is crucial to clarify this distinction. I believe studying this issue in this lesson is of utmost importance.

The diagnostic criteria for diabetes are as follows: fasting blood glucose ≥ 7.0 mmol/L and two-hour postprandial blood glucose ≥ 11.1 mmol/L. Please remember these firmly. These are diagnostic criteria, answering only whether your blood glucose is normal or if you have diabetes. They are absolutely not treatment targets.

Next, let’s discuss treatment targets. There are three types: liberal, general, and strict. The liberal target is fasting blood glucose < 8 mmol/L and two-hour postprandial blood glucose < 12 mmol/L. This target is suitable for elderly individuals in their seventies or eighties with severe complications or weakened health. Lowering blood glucose further would be detrimental to their well-being and counterproductive.

The second is the general target, suitable for individuals around 65 years old with some complications that are not severe, or those who have had diabetes for several years. This target applies to the majority of people. The general target is fasting blood glucose < 7 mmol/L and two-hour postprandial blood glucose < 10 mmol/L. For example, there was an elderly man in his seventies with a fasting blood glucose of 6.8 mmol/L, which was already quite good. However, he believed it was still too high and insisted on lowering it below 6.1 mmol/L. He mistakenly treated the diagnostic criteria as his treatment target. In reality, maintaining it below 7 mmol/L would have been excellent. His盲目 control eventually led to hypoglycemic shock one day.

The third is the strict target, suitable for younger individuals in their thirties, forties, or even fifties who have recently been diagnosed with diabetes. For such individuals, we aim for strict control: fasting blood glucose < 6 mmol/L and two-hour postprandial blood glucose < 8 mmol/L.

Glycemic control targets vary from person to person; there is no one-size-fits-all standard. The appropriate target depends on the individual. Through this explanation, you can identify which target best suits your situation and determine which blood glucose level is most suitable for you.

The general target applies to a broad range of people, meaning the majority follow this standard: fasting blood glucose < 7 mmol/L and two-hour postprandial blood glucose < 10 mmol/L. The liberal and strict targets are relatively less common, with fewer people falling into these categories. Most individuals adhere to the general target. If you are unsure how to evaluate, you can follow the general target. Achieving this—fasting blood glucose < 7 mmol/L and postprandial blood glucose < 10 mmol/L—is relatively safe and minimizes damage from blood glucose fluctuations, which is quite satisfactory.