What is the target fasting blood glucose level for adults on anti-diabetic treatment?

Target Fasting Blood Glucose for Adults on Anti-Diabetic Treatment

For adults on anti-diabetic treatment, the recommended target fasting blood glucose range is 80-130 mg/dL (4.4-7.2 mmol/L). 1

Glycemic Targets Overview

The American Diabetes Association's Standards of Medical Care provides clear guidelines for glycemic targets in adults with diabetes:

• Fasting blood glucose target: 80-130 mg/dL (4.4-7.2 mmol/L) 1
• Peak postprandial glucose target: <180 mg/dL (<10.0 mmol/L) 1
• HbA1c target: <7.0% for most non-pregnant adults 1

Factors Affecting Target Selection

Glycemic targets should be adjusted based on individual patient characteristics:

• More stringent targets (closer to normal range) may be appropriate for: 1

  • Newly diagnosed patients 1
  • Patients with longer life expectancy 1
  • Patients without significant comorbidities 1
  • Patients at low risk for hypoglycemia 1

• Less stringent targets (higher range) may be appropriate for: 1

  • Elderly patients 1
  • Patients with limited life expectancy 1
  • Patients with history of severe hypoglycemia 1
  • Patients with advanced diabetes complications 1
  • Patients with multiple comorbidities 1

Hypoglycemia Considerations

Avoiding hypoglycemia is critical when targeting fasting glucose levels:

• Hypoglycemia alert value: <70 mg/dL (3.9 mmol/L) - requires immediate action 1
• Clinically significant hypoglycemia: <54 mg/dL (3.0 mmol/L) - associated with neuroglycopenic symptoms 1
• Severe hypoglycemia: Altered mental/physical status requiring assistance 1

Patients experiencing hypoglycemia unawareness or severe hypoglycemic events should have their glycemic targets temporarily raised to avoid recurrence 1.

Evidence Supporting Target Range

The 80-130 mg/dL target range is based on several key findings:

• In 2015, the ADA changed its preprandial glycemic target from 70-130 mg/dL to 80-130 mg/dL based on the ADAG study, which demonstrated that higher glycemic targets corresponded better with A1C goals 1
• The higher lower limit (80 mg/dL vs 70 mg/dL) provides a safety margin to limit overtreatment and reduce hypoglycemia risk in patients titrating glucose-lowering medications 1
• The FPG GOAL trial demonstrated that targeting fasting glucose between 3.9-6.1 mmol/L (70-110 mg/dL) achieved better HbA1c control than targeting 3.9-7.0 mmol/L (70-126 mg/dL), but with increased hypoglycemia risk 2

Continuous Glucose Monitoring Targets

For patients using continuous glucose monitoring (CGM):

• Time in range (70-180 mg/dL): >70% of readings 1
• Time below range (<70 mg/dL): <4% of readings 1
• Glycemic variability: coefficient of variation ≤36% 1

Special Considerations

Hospitalized Patients

• ICU patients: Target blood glucose between 140-180 mg/dL (7.8-10.0 mmol/L) 1
• Non-ICU settings: Similar targets, but individualized based on clinical status and hypoglycemia risk 1

Elderly Patients

• Higher fasting targets may be appropriate to reduce hypoglycemia risk 1
• Hypoglycemia in elderly patients is associated with increased risk of falls, cognitive impairment, and mortality 1
• Risk factors for hypoglycemia in elderly include renal failure, sepsis, and low albumin levels 1

Common Pitfalls to Avoid

• Overly aggressive targets in elderly or frail patients can lead to dangerous hypoglycemia 1
• Ignoring patient-specific factors when setting targets 1
• Focusing solely on fasting glucose without considering postprandial values and overall glycemic patterns 1
• Not adjusting targets when patients experience hypoglycemia unawareness or severe hypoglycemic events 1
• Failing to recognize that recurrent hypoglycemia can lead to hypoglycemia unawareness, creating a dangerous cycle 1

By maintaining fasting blood glucose within the 80-130 mg/dL range while avoiding hypoglycemia, most patients can achieve optimal glycemic control that balances the benefits of preventing long-term complications with the risks of treatment.