What are the current Hemoglobin A1c (HbA1c) targets for adults with diabetes?

Current HbA1c Targets for Adults with Diabetes

For most adults with type 2 diabetes, target an HbA1c of 7.0% (53 mmol/mol), with the specific target adjusted based on treatment modality and individual patient factors.

Target Based on Treatment Approach

Lifestyle and Single Non-Hypoglycemic Agent

• Target HbA1c of 6.5% (48 mmol/mol) for adults managed by lifestyle and diet alone, or combined with a single drug not associated with hypoglycemia 1

Medications Associated with Hypoglycemia

• Target HbA1c of 7.0% (53 mmol/mol) for adults on medications that can cause hypoglycemia (such as sulfonylureas or insulin) 1
• This higher target reduces the risk of dangerous hypoglycemic episodes while maintaining benefit for microvascular and macrovascular disease prevention 1

Inadequately Controlled Diabetes

• When HbA1c rises to 7.5% (58 mmol/mol) or higher despite single drug therapy, maintain the target at 7.0% (53 mmol/mol) and intensify treatment 1

Algorithm for Individualizing Targets

Consider MORE STRINGENT targets (6.0-7.0%):

• Short diabetes duration (<5 years) 2
• Treated with lifestyle modifications or metformin only 2
• Long life expectancy (>10-15 years) 2
• Absent or mild microvascular complications 2
• No history of severe hypoglycemia 2
• No significant cardiovascular disease 2

Consider LESS STRINGENT targets (7.0-8.5%):

• History of severe hypoglycemia or impaired awareness of hypoglycemia 1, 2
• Advanced microvascular or macrovascular complications 2
• Extensive comorbid conditions 2
• Long-standing diabetes that is difficult to control 2
• Limited life expectancy (<10 years) 2
• Older adults, particularly those who are frail 1, 2
• High risk of falling 1
• Established cardiovascular disease with 5-10 years life expectancy 2

Critical Pitfalls to Avoid

Overly aggressive targets (below 6.5%) increase mortality risk, weight gain, and severe hypoglycemia in many patients 1, 2. The evidence shows that targeting HbA1c below 7% without careful patient selection can cause more harm than benefit 1.

• Patients spending ≥60% of time below their individualized target range have 12% increased mortality compared to those maintaining time in range 3
• Conversely, patients spending ≥60% of time above target have 10% increased mortality and 11% increased microvascular complications 3

Monitoring Frequency

• Test HbA1c at least twice yearly in patients meeting treatment goals with stable glycemic control 1, 2
• Test quarterly in patients whose therapy has changed or who are not meeting glycemic goals 1, 2
• Testing every 6 months is as effective as quarterly testing for patients with suboptimal control 4

Quality of Life Considerations

Involve patients in decisions about their individual HbA1c target 1. Encourage patients to achieve and maintain their target HbA1c level, unless adverse effects or efforts to achieve the target impair quality of life 1. The goal is not simply a number, but preventing complications while maintaining patient well-being 1.