From the Guidelines
A good value for a fasting HbA1C is generally below 7.0%, but individual goals may vary based on specific health situations, as recommended by the American Diabetes Association in 2023 1. When considering the management of diabetes, it's essential to prioritize individualized treatment targets, taking into account factors such as the patient's age, life expectancy, comorbid conditions, and risk for adverse events.
- For most nonpregnant adults, an HbA1C target <7% (53 mmol/mol) is desirable, balancing the acute risks of hypoglycemia against the long-term benefits on complications 1.
- More stringent targets, such as below 6.5%, may be suitable for younger patients with fewer health complications, while less stringent targets, such as below 8.0%, may be more appropriate for older patients or those with significant comorbid conditions 1.
- The American Diabetes Association recommends individualizing HbA1C goals based on the potential for benefit regarding long-term complications, balanced against the increased risk for hypoglycemia and burden and cost that may attend intensive therapy 1.
- HbA1C measures average blood glucose levels over the past 2-3 months, providing a longer-term picture of glucose control, which is valuable for monitoring diabetes management over time 1.
From the Research
HbA1c Values and Diabetes Control
- The American Diabetes Association recommends an HbA1c goal of less than 7% for most adults with diabetes 2.
- However, a meta-analysis found that lowering HbA1c levels below 7% may not necessarily improve macrovascular outcomes in diabetic patients 2.
- Another study found that combination therapy with exenatide plus pioglitazone was effective in lowering HbA1c levels to below 7% in patients with poorly controlled type 2 diabetes 3.
- A review of low-cost oral hypoglycemic medications found that metformin, glimepiride, and pioglitazone are safe and efficacious options for diabetes treatment, with HbA1c reduction as a key outcome measure 4.
HbA1c Thresholds for Diabetes Prediction
- A study found that HbA1c thresholds for predicting diabetes incidence varied across different cohorts, but generally ranged from 5.1% to 5.7% 5.
- Using a threshold of HbA1c ≥ 5.7% and/or fasting plasma glucose ≥ 5.6 mmol/l to screen for diabetes provided high sensitivity and positive predictive values 5.
Fasting HbA1c Values
- A fasting HbA1c value of less than 5.7% is generally considered normal, while values between 5.7% and 6.4% indicate prediabetes, and values of 6.5% or higher indicate diabetes 5.
- However, the optimal fasting HbA1c value for individuals with diabetes may vary depending on factors such as age, comorbidities, and treatment goals 2, 3, 4.