13
Glycemic Goals
Î Lowering A1c to below or near 7% has been shown to reduce
microvascular complications of diabetes and, if implemented soon
after the diagnosis of diabetes, is associated with long-term reduction
in macrovascular disease. Therefore, a reasonable A1c goal for many
nonpregnant adults is <7%. (B)
Î Providers might reasonably suggest more stringent A1c goals (such
as <6.5%) for selected individual patients if this can be achieved
without significant hypoglycemia or other adverse effects of treatment.
Appropriate patients might include those with short duration of
diabetes, long life expectancy, and no significant CVD. (C)
Î Less stringent A1c goals (such as <8%) may be appropriate for
patients with a history of severe hypoglycemia, limited life expectancy,
advanced microvascular or macrovascular complications, extensive
comorbid conditions, and those with long-standing diabetes in whom
the general goal is difficult to attain despite DSME, appropriate
glucose monitoring, and effective doses of multiple glucose-lowering
agents including insulin. (B)
Table 9. Summary of Glycemic Goals for Many
Nonpregnant Adults with Diabetes
Test Goal
A1c <7.0%
Preprandial capillary plasma glucose 70-130 mg/dL (3.9-7.2 mmol/L)
Peak postprandial capillary plasma glucose
a
<180 mg/dL (<10.0 mmol/L)
• Goals should be individualized based on:
▶ duration of diabetes
▶ age/life expectancy
▶ comorbid conditions
▶ known CVD or advanced microvascular complications
▶ hypoglycemia unawareness
▶ individual patient considerations
• More or less stringent glycemic goals may be appropriate for individual patients.
• Postprandial glucose (PPG)
a
may be targeted if A1c goals are not met despite
reaching preprandial glucose goals.
a
PPG measurements should be made 1-2 h aer the beginning of the meal, generally peak levels in
patients with diabetes.
