2017 ADA Guidelines: Glucose Targets

Last ADA standards were published in January 2017. You could find below the recommended glucose aims for patients with type 1 and type 2 diabetes. Guidelines offer flexibility on A1c targets from <6.5-8.0% depending on person's age, life expectancy, polypharmacy, disease duration, hypoglycemia frequency and comorbidities.

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Diabetes Care

Guidelines

January 2017

 

Recommendations:

  • When used properly, continuous glucose monitoring (CGM) in conjunction with intensive insulin regimens is a useful tool to lower A1C in selected adults (aged ≥25 years) with type 1 diabetes.

  • CGM may be a useful tool in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes.

  • Given the variable adherence to CGM, assess individual readiness for continuing CGM use prior to prescribing.

  • People who have been successfully using CGM should have continued access after they turn 65 years of age.

  • Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control).

  • Perform the A1C test every 3 months in patients whose therapy has changed or who are not meeting glycemic goals.

A1C reflects average glycemia over approximately 3 months and has strong predictive value for diabetes complications. Thus, A1C testing should be performed routinely in all patients with diabetes — at initial assessment and as part of continuing care.

The A1C test is an indirect measure of average glycemia and, as such, is subject to limitations. Conditions that affect red blood cell turnover (hemolysis, blood loss) and hemoglobin variants must be considered, particularly when the A1C result does not correlate with the patient’s SMBG levels.

 

  • A reasonable A1C goal for many non-pregnant adults is <7%

  • Providers might reasonably suggest MORE stringent A1C goals (such as <6.5%) for selected individual patients if this can be achieved without significant hypoglycemia or other adverse effects of treatment (i.e., polypharmacy).

Appropriate patients might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant CVD

  • LESS stringent A1C goals (such as <8%) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal is difficult to achieve despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin.