Glucose and A1C Goals
- 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.
- 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).
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.