From the Guidelines
The best answer is a target A1C of 7.0% or less as long as there is low risk for severe hypoglycemic events. This recommendation is based on the guidance statement from the American College of Physicians, which suggests that clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes 1. The statement emphasizes the importance of personalizing goals for glycemic control, taking into account the benefits and harms of pharmacotherapy, patient preferences, general health, life expectancy, treatment burden, and costs of care. Key points to consider include:
- The American College of Physicians guidance statement is based on a review of several national guidelines and a systematic evaluation of the evidence using the AGREE II instrument 1.
- The statement highlights the need to balance the benefits of intensive glycemic control with the potential harms, including hypoglycemia, weight gain, and increased treatment burden 1.
- A target A1C of 7.0% or less is recommended for most patients, but this target should be individualized based on the patient's specific circumstances, including their risk for hypoglycemia, diabetes duration, and overall health status 1.
- For patients with limited life expectancy or multiple comorbid conditions, a less stringent target may be appropriate, focusing on minimizing symptoms rather than achieving a specific HbA1c level 1. Overall, the goal is to find a balance between effective diabetes management and safety considerations, taking into account the individual patient's needs and circumstances.
From the Research
Target A1C Levels
The target A1C level for EC can be determined based on several factors, including age, duration of diabetes, and risk of hypoglycemic events.
- A target A1C of 7.0% or less is recommended for many children with type 1 diabetes, with an emphasis on target personalization 2.
- A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness 2.
- 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 3.
Factors Influencing Target A1C
Several factors can influence the target A1C level, including:
- Baseline HbA1c level: Lower baseline HbA1c is associated with a higher likelihood of reaching the target HbA1c of ≤7.0% 4.
- Risk of hypoglycemic events: A higher A1C target may be more suitable for individuals with a history of severe hypoglycemia or hypoglycemia unawareness 2.
- Age and duration of diabetes: The target A1C level may need to be adjusted based on the individual's age and duration of diabetes 2.
Recommended Target A1C
Based on the available evidence, a target A1C of 7.0% or less is a reasonable goal for many individuals with diabetes, as long as there is a low risk for severe hypoglycemic events 3, 2, 5. However, the target A1C level should be personalized based on individual factors, such as age, duration of diabetes, and risk of hypoglycemic events.