Rethinking A1C targets for patients with mental illness?

The article, “Diabetes update: Your guide to the latest ADA standards,” by Shubrook, et al (J Fam Pract. 2016;65:310-318) is a precise review of current recommendations for diabetes. We would like to draw attention, however, to comorbid diabetes and mental illness.

Diabetes and serious mental illness often coincide, making the treatment of both conditions difficult and leading to higher rates of complications.¹

The American Diabetes Association (ADA)’s “Standards of Medical Care in Diabetes” recognizes that hemoglobin A1C targets for patients should be individualized.² We consider it important to discuss challenges and limitations with each patient.

For example, a more lenient A1C goal may be appropriate when:

• the assessment of the patient shows that he or she is struggling with active symptoms of mental illness
• new medications with undesirable metabolic effects are prescribed or titrated
• social support is poor
• patients have limited confidence in their ability to accomplish tasks and goals
• patients have cognitive limitations
• patients abuse substances.