What is the target Hemoglobin A1c (HbA1c) level for a patient with diabetes?

From the Guidelines

The goal A1C for most adults with diabetes should be between 7% and 8%, as this range balances the benefits of glycemic control with the risks of hypoglycemia and treatment burden, according to the American College of Physicians guidance statement 1. This target may be individualized based on specific patient factors, such as age, comorbidities, and life expectancy. For example, younger patients with no significant health issues may aim for a stricter target of less than 7%, while older adults or those with multiple health conditions may have a more relaxed target of 7% to 8% 1. The choice of glycemic target also depends on consideration of other variables, such as risk for hypoglycemia, weight gain, and other drug-related adverse effects, as well as the patient's age, life expectancy, other chronic conditions, functional and cognitive impairments, fall risk, ability to adhere to treatment, and medication burden and cost 1. Regular blood glucose monitoring, quarterly A1C testing, and ongoing diabetes education are essential components of diabetes management to reach and maintain target A1C levels. Additionally, lifestyle modifications, such as a healthy diet, regular physical activity, and weight management, are crucial in achieving and maintaining good glycemic control 1. It is also important to consider the potential harms of intensive glycemic control, including hypoglycemia, weight gain, and increased treatment burden, and to individualize treatment goals accordingly 1. Overall, the goal A1C for adults with diabetes should be personalized and based on a discussion of the benefits and harms of pharmacotherapy, patient preferences, and individual patient characteristics 1.

Some key points to consider when determining the goal A1C for adults with diabetes include:

• The American College of Physicians recommends a goal A1C of 7% to 8% for most adults with diabetes 1
• Individualized targets may be necessary based on patient factors, such as age, comorbidities, and life expectancy 1
• Lifestyle modifications, such as a healthy diet and regular physical activity, are essential for achieving and maintaining good glycemic control 1
• Regular blood glucose monitoring and quarterly A1C testing are necessary to assess glycemic control and adjust treatment as needed 1
• The potential harms of intensive glycemic control, including hypoglycemia and weight gain, should be considered when determining treatment goals 1.

It is also important to note that the evidence from trials included in the guidance statement is insufficient to evaluate the effect of HbA1c targets between 6.5% and 7% on clinical outcomes, and further research would be needed to close this gap 1. However, the available evidence suggests that treating to targets of 7% or less compared with targets around 8% did not reduce death or macrovascular events over about 5 to 10 years of treatment but did result in substantial harms, including hypoglycemia 1. Therefore, the goal A1C for most adults with diabetes should be between 7% and 8%, as this range balances the benefits of glycemic control with the risks of hypoglycemia and treatment burden.

From the FDA Drug Label

Although there was no statistically significant difference between ACTOS and placebo for the 3-year incidence of a first event within this composite, there was no increase in mortality or in total macrovascular events with ACTOS The goal A1c for diabetic patients is not explicitly stated in the provided drug labels.

• The labels provide information on the effects of pioglitazone on glycemic control in patients with type 2 diabetes, including reductions in HbA1c levels.
• However, they do not specify a target or goal A1c level for diabetic patients.
• Clinical decisions regarding A1c goals should be made on a case-by-case basis, taking into account individual patient factors and guidelines from relevant medical organizations 2, 2, 2.

From the Research

Goal A1C for Diabetics

• The American Diabetes Association (ADA) 2013 guidelines state that a reasonable hemoglobin A1c goal for many nonpregnant adults with diabetes is less than 7.0% 3
• A hemoglobin A1c level of less than 6.5% may be considered in adults with short duration of diabetes, long life expectancy, and no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects of treatment 3
• A hemoglobin A1c level less than 8.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced macrovascular and microvascular complications, extensive comorbidities, and long-standing diabetes in whom the hemoglobin A1c goal is difficult to attain despite multiple glucose-lowering drugs including insulin 3

Comparison of Therapies

• Metformin-based dual therapies with sulfonylurea, pioglitazone, or DPP4-inhibitor showed similar glycemic effectiveness among drug-naïve Korean type 2 diabetic patients 4
• Liraglutide was more effective than Glimepiride, Pioglitazone, Sitaglitin, Exenatide, and Glipizide at reducing glycated hemoglobin (HbA1c) levels 5
• Acarbose was less effective than Glibenclamide, Glimepiride, Pioglitazone, Rosiglitazone, Repaglinide, Metformin, and Liraglutide at decreasing HbA1c levels 5

Other Considerations

• The choice of therapy should be individualized based on patient characteristics, such as duration of diabetes, life expectancy, and presence of cardiovascular disease 3
• The goal of therapy is to achieve a balance between glycemic control and minimizing adverse effects, such as hypoglycemia 3