U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Monday, November 24, 2014

Division of Diabetes Treatment and Prevention - Leading the effort to treat and prevent diabetes in American Indians and Alaska Natives


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Glucose and A1C Goals

Glucose Control Algorithm Card
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NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.

  • The A1C target, in general, is <7% in non-pregnant patients. However, A1C goals should be individualized:
    • Consider more stringent goals (<6.5-7%) for some patients (e.g., younger, more recently diagnosed non-elderly patients without pre-existing heart disease or other significant comorbidities).
      • Early intensive treatment reduces risk for microvascular disease and, in long-term follow-up, for major CVD outcomes.
    • Consider less stringent goals for some patients: (e.g., older patients, those who have advanced complications of diabetes, CVD or other significant comorbidity, patients with longstanding diabetes in whom achieving tighter control is difficult despite appropriate therapies).
      • Tight glycemic control increases the risk for hypoglycemia and perhaps mortality in older patients with comorbidities.
  • A1C testing may be repeated as soon as one month later to assess response to changes in therapy, or every 3-6 months in “stable” patients.
  • Point-of-care (POC) A1C testing allows providers to make timely decisions on therapy changes.

Glucose Goals*

  • Fasting and premeal blood glucose target =70 to 130 mg/dL
  • Peak postprandial blood glucose target <180 mg/dL
  • A1C target <7%

*Individualize targets based on patient characteristics (e.g., age, life expectancy, comorbid conditions including advanced CVD or microvascular complications, social situation).

Reference:
Skyler JS, et.al. Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials: A position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association Diabetes Care 2009; 32:187-192.

 
Overview How To Other Resources

Division of Diabetes Treatment and Prevention | Phone: (505) 248-4182 | Fax: (505) 248-4188 | diabetesprogram@ihs.gov