ADA Blood Sugar Targets for Adult Type 2 Diabetes
The American Diabetes Association recommends an A1C <7.0% (53 mmol/mol), preprandial glucose 80-130 mg/dL (4.4-7.2 mmol/L), and peak postprandial glucose <180 mg/dL (10.0 mmol/L) for most nonpregnant adults with type 2 diabetes. 1
Standard Glycemic Targets
The core ADA targets apply to the majority of nonpregnant adults with type 2 diabetes 1:
- A1C target: <7.0% (53 mmol/mol) 1
- Preprandial capillary plasma glucose: 80-130 mg/dL (4.4-7.2 mmol/L) 1
- Peak postprandial capillary plasma glucose: <180 mg/dL (10.0 mmol/L) 1
The preprandial target was revised in 2015 from 70-130 mg/dL to 80-130 mg/dL based on the ADAG study, which demonstrated that higher glycemic targets corresponded better to A1C goals and provided a safety margin to limit overtreatment and hypoglycemia risk in patients titrating insulin 1.
When to Intensify Targets (A1C <6.5%)
More stringent A1C targets of <6.5% are appropriate for patients meeting all of the following criteria 1:
- Short duration of diabetes
- Long life expectancy (>10-15 years)
- No established cardiovascular disease
- Absent or few/mild comorbidities
- Low risk of hypoglycemia
- High motivation with excellent self-care capabilities
- Readily available resources and support
When to Relax Targets (A1C <8.0%)
Less stringent A1C targets of <8.0% are appropriate for patients with any of the following 1:
- Long-standing diabetes (>10-15 years)
- Short life expectancy (<10 years)
- Severe comorbidities
- Established vascular complications
- History of severe hypoglycemia or hypoglycemia unawareness
- High risk of hypoglycemia and other drug adverse effects
- Preference for less burdensome therapy
- Limited resources and support
The American College of Physicians recommends an A1C target of 7-8% for most patients with type 2 diabetes, with deintensification for those achieving A1C <6.5% 1.
Critical Safety Considerations
Hypoglycemia prevention takes absolute precedence over achieving A1C targets. 1 Patients with the following conditions should have their glycemic targets raised to strictly avoid further hypoglycemia 1:
- Hypoglycemia unawareness
- One or more episodes of level 3 hypoglycemia (severe hypoglycemia requiring assistance)
- Pattern of unexplained level 2 hypoglycemia (glucose <54 mg/dL)
- History of severe hypoglycemia
Severe or frequent hypoglycemia is an absolute indication for treatment regimen modification, including setting higher glycemic goals 1.
Monitoring Frequency
- A1C testing at least twice yearly in patients meeting treatment goals with stable glycemic control 1
- A1C testing quarterly in patients whose therapy has changed or who are not meeting glycemic goals 1
Common Pitfalls to Avoid
Do not aggressively pursue near-normal A1C levels in patients with advanced disease, limited life expectancy, or high hypoglycemia risk, as the potential risks of intensive glycemic control may outweigh benefits in higher-risk individuals 1. The ACCORD trial demonstrated increased mortality with intensive glycemic control in patients with long-standing type 2 diabetes and established cardiovascular disease 1.
Avoid overtreatment in patients already achieving A1C <6.5%, as this increases hypoglycemia risk without additional benefit 1.
Reassess glycemic targets over time as patient characteristics change, such as comorbidities emerging, life expectancy decreasing, or diabetes becoming more difficult to control 1.
Daily Glucose Monitoring Targets
For patients performing self-monitoring of blood glucose 2:
- Fasting/premeal glucose: <130 mg/dL 2
- Postprandial glucose: <180 mg/dL (measured 1-2 hours after meal initiation) 2
- Mean plasma glucose: 150-160 mg/dL to achieve A1C <7.0% 2
Fasting glucose alone is insufficient for assessing glycemic control—both fasting and postprandial targets matter 2. The correlation between A1C and postprandial glucose is strongest when A1C is in the 7-8% range 3.