What is the HbA1c goal for Type 2 Diabetes Mellitus patients requiring insulin therapy?

From the Guidelines

The general HbA1c goal for most adults with type 2 diabetes requiring insulin therapy is less than 7%. For patients on insulin therapy, aim for fasting and pre-meal blood glucose levels of 80-130 mg/dL (4.4-7.2 mmol/L) and post-meal levels less than 180 mg/dL (10.0 mmol/L) to achieve this HbA1c target, as recommended by the American Diabetes Association [@2@]. However, individualization is key:

• For younger patients with no comorbidities, a stricter goal of <6.5% may be appropriate.
• For older adults or those with multiple comorbidities, a less stringent goal of <8% may be suitable, as suggested by the American Geriatrics Society [@3@]. To achieve these targets:

1. Start with basal insulin (e.g., glargine, detemir) once daily.
2. Adjust dose based on fasting glucose levels.
3. Add mealtime insulin (e.g., lispro, aspart) if needed.
4. Monitor blood glucose regularly and adjust insulin doses accordingly. This approach balances glycemic control with the risk of hypoglycemia, which is supported by the American College of Physicians guidance statement 1. Tighter control reduces microvascular complications, but overly aggressive targets in insulin-requiring patients can increase hypoglycemia risk, which is particularly dangerous in older or frail individuals. The Canadian Diabetes Association also emphasizes the importance of individualized glycemic targets [@4@].

From the FDA Drug Label

In a 24-week, non-blinded, randomized, clinical study (Study E, n=476), LEVEMIR administered twice-daily (before breakfast and evening) was compared to a similar regimen of NPH human insulin as part of a regimen of combination therapy with one or two of the following oral antidiabetes agents (metformin, insulin secretagogue, or α–glucosidase inhibitor) LEVEMIR and NPH similarly lowered HbA1c from baseline (Table 3). Table 3: Efficacy and Insulin Dosage in Type 2 Diabetes Mellitus Study E Treatment duration24 weeks Treatment in combination withOAD LEVEMIRNPH Number of subjects treated237239 HbA1c (%) Baseline8.618.51 End of study adjusted mean6.586.46 Mean change from baseline-1.84-1. 90 Proportion achieving HbA1c ≤ 7%70%74%

The HbA1c goal for Type 2 Diabetes Mellitus patients requiring insulin therapy is not explicitly stated in the provided drug labels. However, based on the study results, a proportion of patients achieved an HbA1c ≤ 7%, with 70% of LEVEMIR-treated patients and 74% of NPH-treated patients reaching this goal 2.

From the Research

HbA1c Goal for Type 2 Diabetes Mellitus Patients Requiring Insulin Therapy

• The general consensus of HbA1c target for most patients is less than 7% 3
• 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 4
• For patients with type 2 diabetes mellitus treated with basal insulin, the mean HbA1c values in the uncontrolled groups were 8.15% (65.6 mmol/mol) 5
• A study found that the proportion of patients who achieved the HbA1c goal ranged from 25.9% (95% CI 18.5-34.9) with α-glucosidase inhibitors to 63.2% (54.1-71.5) with the long-acting GLP-1 analogue, and 57.8% for HbA1c ≤7.5% to 20.8% for HbA1c ≥10% (p for trend <0.0001) 6
• Another study showed that the mean individualized HbA1c goal was 6.8% (0.68%) and only about 40% of patients achieved their individualized HbA1c goal 7
• Treatment intensification was often delayed until HbA1c was 8% and higher 7
• Patients aware of their HbA1c goal were slightly more adherent to their antihyperglycemic medication, however, awareness of HbA1c goal did not enhance goal attainment 7