What is the HbA1c (Hemoglobin A1c) target for type 2 diabetes mellitus?

From the Guidelines

The A1C target for most patients with type 2 diabetes should be between 7% and 8%. This target range is based on the balance of benefits and harms of glycemic control, as evidenced by several large, long-term randomized controlled trials 1. These trials have shown 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.

Key Considerations

• The choice of glycemic target 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.
• Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care 1.
• For patients with a life expectancy less than 10 years due to advanced age, residence in a nursing home, or chronic conditions, the goal should be to minimize symptoms related to hyperglycemia rather than achieving a specific HbA1c target 1.
• Any benefit of more intensive glycemic control likely requires a long time to manifest, and more stringent targets may be appropriate for patients who have a long life expectancy and are interested in more intensive glycemic control with pharmacologic therapy despite the risk for harms.

Individualized Approach

• The American College of Physicians guidance statement recommends an HbA1c target range between 7% and 8% for most patients with type 2 diabetes, with consideration for individualizing targets based on patient characteristics and preferences 1.
• Other guidelines, such as those from the American Diabetes Association, also recommend individualized HbA1c targets, with more stringent goals for selected patients and less stringent goals for those with limited life expectancy or advanced complications 1.

Monitoring and Adjustment

• Regular A1C testing should be performed every 3-6 months, depending on how well the patient is meeting their target and whether treatment changes have been made.
• The A1C result should be considered alongside daily glucose monitoring results when making treatment decisions.

From the Research

A1C Target for Type 2 Diabetes

• The current guidelines specify hemoglobin A1c (HbA1c) targets around or less than 7.0 %, with more (<6.5 %) or less (<8 %) stringent goals being appropriate for selected patients 2.
• The American College of Physicians (ACP) published a guideline on HbA1c targets for nonpregnant adults with type 2 diabetes, recommending a level between 7% and 8% for most patients 3.
• The American Diabetes Association recommends aiming for HbA1c levels less than 7% for many nonpregnant adults and considering a target of 6.5% if it can be achieved safely 3.
• The choice of HbA1c target depends on various factors, including the patient's individual characteristics, comorbidities, and risk of hypoglycemia or other adverse effects 2, 4, 3.
• GLP-1 receptor agonists are recommended as the preferred first injectable glucose-lowering therapy for type 2 diabetes, with a similar or superior effectiveness for HbA1c reduction and additional weight reduction 5.

Factors Influencing A1C Targets

• The patient's life expectancy, with deintensification of therapy recommended for patients with a life expectancy of less than 10 years 3.
• The presence of comorbidities, such as cardiovascular disease, kidney disease, or hypoglycemia 4, 3.
• The patient's individual characteristics, such as age, weight, and lifestyle 2, 4, 3.
• The risk of therapeutic inertia, which can be avoided by setting appropriate HbA1c targets and adjusting treatment accordingly 2, 6.

Treatment Strategies

• The use of GLP-1 receptor agonists, which have been shown to be effective in reducing HbA1c levels and weight, with a low risk of hypoglycemia 5.
• The combination of GLP-1 receptor agonists with basal insulin, which can be effective in achieving HbA1c targets 6, 5.
• The use of other glucose-lowering agents, such as metformin, sulfonylureas, or SGLT-2 inhibitors, which can be effective in achieving HbA1c targets 6, 4, 5.