From the Guidelines
The American College of Physicians recommends aiming to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes. This recommendation is based on the latest evidence from high-quality studies, including the 2024 visual clinical guideline from the American College of Physicians 1. The guideline emphasizes the importance of individualizing glycemic goals based on risk for hypoglycemia, life expectancy, diabetes duration, established vascular complications, major comorbidities, patient preferences, and access to resources.
Some key points to consider when interpreting HbA1c levels include:
- HbA1c levels between 5.7% and 6.4% indicate prediabetes
- HbA1c levels of 6.5% or higher indicate diabetes
- Individualized glycemic goals should be based on patient-specific factors, such as risk for hypoglycemia and life expectancy
- Deintensification of pharmacologic treatments may be necessary in adults with HbA1c levels less than 6.5%
The American College of Physicians' recommendation to aim for an HbA1c level between 7% and 8% is supported by evidence from several high-quality studies, including the ACCORD, ADVANCE, UKPDS, and VADT trials 1. These studies demonstrate that intensive glycemic control to HbA1c levels below 7% does not consistently reduce clinical microvascular events or macrovascular events, but may increase the risk of hypoglycemia and other adverse effects.
In clinical practice, it is essential to consider the individual patient's characteristics, preferences, and values when determining the target HbA1c level. The American College of Physicians' guideline provides a framework for clinicians to make informed decisions about glycemic control in adults with type 2 diabetes. By aiming for an HbA1c level between 7% and 8%, clinicians can help minimize the risk of hypoglycemia and other adverse effects while still providing effective glycemic control.
From the Research
A1c Normal Range ADA
- The American Diabetes Association (ADA) recommends an A1c goal of less than 7% for most adults with diabetes 2.
- However, the ADA also suggests that less stringent A1c goals (such as <8%) may be appropriate for some individuals, particularly older adults with complex or poor health status 3.
- Studies have shown that achieving an A1c level of less than 7% can be beneficial for patients with type 2 diabetes, particularly when using combination therapies such as pioglitazone and metformin 2, 4, 5, 6.
- The normal range for A1c is generally considered to be between 4% and 5.6%, but the ADA recommends an A1c goal of less than 7% for most adults with diabetes 3.
Factors Influencing A1c Goals
- Age: older adults may have different A1c goals due to comorbid health status and risk of hypoglycemia 3.
- Health status: individuals with complex or poor health status may have less stringent A1c goals 3.
- Medication use: the use of certain medications, such as pioglitazone and sitagliptin, may influence A1c goals 2, 4, 5, 6.
Clinical Implications
- Achieving an A1c level of less than 7% can reduce the risk of microvascular complications and improve glycemic control in patients with type 2 diabetes 2, 4, 5, 6.
- However, less stringent A1c goals may be appropriate for some individuals, particularly older adults with complex or poor health status 3.
- Clinicians should consider individual patient factors, such as age and health status, when determining A1c goals and developing treatment plans 3.