Figure 6. Conceptual Model for Classifying Hemoglobin A_1c Distribution Among U.S. Adults with Diabetes, NHANES 2011–2012.

Abbreviations: NHANES, National Health and Nutrition Examination Survey. The current paradigm of glucose management in type 2 diabetes is to classify adults as being “controlled” (solid shaded grey area) if the hemoglobin A_1C level is less than 7%, and “uncontrolled” if the hemoglobin A_1C level is greater than 7% (solid shaded light grey area). Since this classification does not define whether treating glucose to lower levels is beneficial for an individual patient, we propose classifying diabetes as asymptomatic and symptomatic (shaded areas indicated by dashed lines), such that for asymptomatic patients a shared decision making discussion between the patient and clinician should occur first before reflexively treating glucose to lower levels. Although we dichotomize this distinction at 9% at the population level, patients may have symptoms related to hyperglycemia at lower values of hemoglobin A_1C.