Target Blood Chemistry Results for Diabetic Patients
For most diabetic patients, the recommended HbA1c target is between 7% and 8%, with preprandial (before meal) blood glucose of 80-130 mg/dL and postprandial (after meal) blood glucose of <180 mg/dL. 1
HbA1c Targets
- The American Diabetes Association recommends an HbA1c target of <7% (53 mmol/mol) for many nonpregnant adults with diabetes 1
- The American College of Physicians recommends an HbA1c target range of 7-8% for most patients with type 2 diabetes 1, 2
- More stringent targets (closer to 6.5%) may be appropriate for patients with newly diagnosed diabetes, long life expectancy (>15 years), and no significant cardiovascular disease, if achievable without significant hypoglycemia 1
- Less stringent targets (7.5-8.5%) are appropriate for patients with limited life expectancy, extensive comorbid conditions, history of severe hypoglycemia, or advanced complications 1, 2
Blood Glucose Targets
Preprandial (Before Meals) Targets
- 80-130 mg/dL (4.4-7.2 mmol/L) 1
- To achieve an HbA1c of 6.5-6.99%, average fasting blood glucose should be approximately 142 mg/dL (135-150 mg/dL) 3
- To achieve an HbA1c of 7.0-7.49%, average fasting blood glucose should be approximately 152 mg/dL (143-162 mg/dL) 3
Postprandial (1-2 Hours After Meals) Targets
- <180 mg/dL (10.0 mmol/L) 1
- To achieve an HbA1c of 6.5-6.99%, average postmeal blood glucose should be approximately 139 mg/dL (134-144 mg/dL) 3
- To achieve an HbA1c of 7.0-7.49%, average postmeal blood glucose should be approximately 152 mg/dL (147-157 mg/dL) 3
Bedtime Targets
- To achieve an HbA1c of 6.5-6.99%, average bedtime blood glucose should be approximately 153 mg/dL (145-161 mg/dL) 3
- To achieve an HbA1c of 7.0-7.49%, average bedtime blood glucose should be approximately 177 mg/dL (166-188 mg/dL) 3
Special Considerations
Hypoglycemia Prevention
- Hypoglycemia is defined as blood glucose <70 mg/dL (3.9 mmol/L) 1
- Level 2 hypoglycemia (blood glucose <54 mg/dL or 3.0 mmol/L) requires immediate treatment and may warrant adjustment of glycemic targets 1
- Patients with hypoglycemia unawareness, history of severe hypoglycemia, or pattern of unexplained hypoglycemia should have their glycemic targets raised to avoid further hypoglycemia 1
Monitoring Recommendations
- HbA1c should be measured at least twice yearly in patients meeting treatment goals with stable glycemic control 1
- HbA1c should be measured quarterly in patients whose therapy has changed or who are not meeting glycemic goals 1, 2
- Self-monitoring of blood glucose (SMBG) is an essential tool to assess therapy and detect incipient hypoglycemia 1
- Continuous glucose monitoring (CGM) can be particularly useful for patients with complicated diabetes or frequent hypoglycemia 1
Algorithm for Target Selection
Assess patient characteristics:
- Age and life expectancy
- Duration of diabetes
- Comorbid conditions
- Risk of hypoglycemia
- Patient preferences and ability to adhere to treatment
Select appropriate HbA1c target:
- Standard target (most patients): 7-8% 1, 2
- More stringent target (6.5-7%): Younger patients, newly diagnosed, long life expectancy, no cardiovascular disease 1
- Less stringent target (7.5-8.5%): Elderly patients (>80 years), limited life expectancy, multiple comorbidities, history of severe hypoglycemia 1
Set corresponding blood glucose targets:
Common Pitfalls to Avoid
- Setting overly aggressive targets (HbA1c <6.5%) for patients with multiple comorbidities or at high risk for hypoglycemia 1, 2
- Relying solely on fasting plasma glucose measurements to assess glycemic control 4
- Failing to adjust targets as patient circumstances change (e.g., development of comorbidities, aging) 2
- Not considering the increased risk of hypoglycemia with intensive control, especially in patients with renal impairment 2
- Overlooking the importance of postprandial glucose control, which can significantly contribute to overall glycemic control even when fasting glucose is at target 5, 4