What HbA1c (hemoglobin A1c) level constitutes good diabetic control?

From the Guidelines

Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes. This recommendation is based on the American College of Physicians' guidance statement update from 2018 1, which suggests that targeting an HbA1c level between 7% and 8% is appropriate for most patients with type 2 diabetes. The statement is adapted from and most consistent with the Institute for Clinical Systems Improvement (ICSI) guideline, which recommends an HbA1c target range between less than 7% and less than 8% 1.

Key Considerations

• The American College of Physicians' guidance statement update from 2018 1 emphasizes the importance of personalizing goals for glycemic control in patients with type 2 diabetes.
• The statement suggests that clinicians should consider the benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care when setting HbA1c targets.
• The ICSI guideline highlights that efforts to achieve HbA1c levels below 7% may increase the risk for death, weight gain, hypoglycemia, and other adverse effects in many patients 1.

Individualized Targets

• For patients with newly diagnosed diabetes and those without substantial diabetes-related complications, a target in the lower end of the range (7%) may be appropriate 1.
• For patients with multiple comorbid conditions, limited life expectancy, or increased risk for hypoglycemia, a more relaxed target of 7.5-8% may be appropriate 1.
• Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5% 1.

Monitoring and Adjustment

• Regular HbA1c testing (typically every 3-6 months) is essential for monitoring diabetes management effectiveness 1.
• Clinicians should reevaluate HbA1c levels and revise treatment strategies on the basis of changes in the balance of benefits and harms due to changed costs of care and patient preferences, general health, and life expectancy 1.

From the FDA Drug Label

Although most patients in the previously-treated group had a decrease from baseline in HbA1c and FPG with ACTOS, in many cases the values did not return to screening levels by the end of the study.

The FDA drug label does not answer the question.

From the Research

HbA1c Levels for Good Diabetic Control

• The American Diabetes Association recommends an HbA1c target of less than 7% for most adults with diabetes 2.
• However, individualized HbA1c goals may vary, and some studies suggest that a target HbA1c range of 7-7.7% may be more appropriate for reducing microvascular and macrovascular events in type 2 diabetes, regardless of duration of diabetes 3.
• A real-world multinational survey found that the mean individualized HbA1c goal was 6.8%, and only about 40% of patients achieved their individualized HbA1c goal 4.
• Another study found that adding basal insulin to metformin and DPP-4 inhibitors with or without sulfonylurea was safe and efficient in reducing HbA1c levels, with 31.7% of subjects achieving a target HbA1c level of ≤7.0% 5.
• The optimal HbA1c target may depend on various factors, including the patient's treatment benefits, safety, and tolerability, as well as their awareness and adherence to their antihyperglycemic medication 4, 6.

Factors Influencing HbA1c Targets

• Patient awareness of their HbA1c goal was found to be associated with slightly better adherence to antihyperglycemic medication, but did not enhance goal attainment 4.
• Treatment intensification was often delayed until HbA1c was 8% or higher, highlighting the need for a holistic approach to diabetes management, involving patient education, and patient-physician communication and partnership 4.
• The choice of antidiabetic drug and the patient's response to treatment may also influence the optimal HbA1c target 2, 6.