Blood Sugar Targets for Type 2 Diabetics
For most adults with type 2 diabetes, target an HbA1c of less than 7% (53 mmol/mol), with fasting/premeal glucose less than 130 mg/dL (7.2 mmol/L) and postprandial glucose less than 180 mg/dL (10.0 mmol/L). 1
Standard HbA1c Target: <7%
The primary HbA1c goal is <7% for most non-pregnant adults with type 2 diabetes to reduce microvascular complications (retinopathy, nephropathy, neuropathy), as recommended by the ADA and EASD. 1, 2
This target corresponds to a mean plasma glucose of 150-160 mg/dL (8.3-8.9 mmol/L). 1
The American College of Physicians recommends a slightly broader target range of 7-8% for most adults, acknowledging that overly aggressive control may not benefit everyone. 1, 2
Daily Glucose Targets
Fasting and premeal glucose should be maintained at <130 mg/dL (<7.2 mmol/L). 1
Postprandial glucose (measured 1-2 hours after meals) should be <180 mg/dL (<10.0 mmol/L). 1
A casual postprandial glucose >150 mg/dL predicts inadequate control (HbA1c ≥7%) with 78% sensitivity and can trigger therapy intensification when rapid HbA1c testing is unavailable. 3
When to Target More Stringent Control: HbA1c <6.5%
Consider tighter targets (HbA1c 6.0-6.5%) only in highly selected patients who meet ALL of the following criteria: 1, 2
- Short disease duration (newly diagnosed)
- Long life expectancy (>10 years)
- No significant cardiovascular disease
- Managed with lifestyle modifications or metformin alone
- Low risk for hypoglycemia
- Target achievable without significant adverse effects
The rationale is that early aggressive control may provide long-term benefits, but this must be balanced against hypoglycemia risk and treatment burden. 1
When to Target Less Stringent Control: HbA1c 7.5-8.0% or Higher
Relax targets to HbA1c 7.5-8.0% (or even slightly higher) for patients with ANY of the following: 1, 2
- History of severe hypoglycemia
- Limited life expectancy (<5-10 years)
- Advanced microvascular or macrovascular complications
- Extensive comorbid conditions (multiple chronic diseases)
- Older age or frailty
- Difficulty achieving target despite intensive therapy with multiple agents including insulin
The evidence from cardiovascular outcome trials demonstrates that not everyone benefits from aggressive glucose management, and some patients may experience harm from overly tight control. 1
Critical Clinical Pitfalls to Avoid
Do not use HbA1c <7% as a universal quality metric for all patients—this contradicts the principle of individualization and may lead to overtreatment in vulnerable populations. 1
Do not ignore hypoglycemia risk, particularly in patients with kidney impairment, elderly patients, or those on insulin or sulfonylureas. 2
Do not set overly aggressive targets for elderly or frail patients—the risk of hypoglycemia and treatment burden outweighs potential benefits. 2
Do not fail to adjust targets as circumstances change—reassess when new comorbidities develop, functional status declines, or life expectancy shortens. 2
Do not focus solely on HbA1c while ignoring quality of life and treatment burden—patient preferences and ability to manage complex regimens must factor into target selection. 1, 2
Monitoring Frequency
Check HbA1c every 3 months until target is achieved, then every 6 months once stable. 2, 4
If HbA1c target is not achieved within 3-6 months, intensify therapy rather than continuing ineffective treatment. 4
Progressive Nature of Disease
Recognize that type 2 diabetes is a progressive disease—monotherapy becomes increasingly ineffective over time, with only 25% of patients maintaining HbA1c <7% after 9 years on single-agent therapy. 5 This means most patients will require combination therapy or insulin eventually, and targets may need adjustment as beta-cell function declines. 5