| VA/DoD [17] |
2017 |
We recommend setting an HbA1c target range based on absolute risk reduction of significant microvascular complications, life expectancy, patient preferences, and social determinants of health. We suggest a target HbA1c range of 6.0–7.0% (42–53 mmol/mol) for patients with a life expectancy greater than 10–15 years and absent or mild microvascular complications, if it can be safely achieved. We recommend that in patients with type 2 diabetes, a range of HbA1c 7.0–8.5% (53–69 mmol/mol) is appropriate for most individuals with established microvascular or macrovascular disease, comorbid conditions, or 5–10 years life expectancy, if it can be safely achieved. We suggest a target HbA1c range of 8.0–9.0% (64–75 mmol/mol) for patients with type 2 diabetes with life expectancy <5 years, significant comorbid conditions, advanced complications of diabetes, or difficulties in self-management attributable to, for example, mental status, disability, or other factors such as food insecurity and insufficient social support.
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| ADA/EASD [28] |
2018 |
A reasonable HbA1c target for most non-pregnant adults with sufficient life expectancy to see microvascular benefits (generally ~10 years) is around 53 mmol/mol (7.0%) or less. Glycemic treatment targets should be individualized based on patient preferences and goals, risk of adverse effects of therapy (eg, hypoglycemia and weight gain) and patient characteristics, including frailty and comorbid conditions.
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| ACP [42] |
2018 |
Clinicians should aim to achieve an HbA1c level between 7.0% and 8.0% (53–64 mmol/mol) in most patients with type 2 diabetes. Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels <6.5% (48 mmol/mol). Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients’ preferences, patients’ general health and life expectancy, treatment burden, and costs of care.
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| AACE/ACE [30] |
2019 |
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| ADA [41] |
2021 |
HbA1c <7.0% (53 mmol/mol). Preprandial capillary plasma glucose 80–130 mg/dL* (4.4–7.2 mmol/L). Peak postprandial capillary plasma glucose 180 mg/dL† (10.0 mmol/L). More or less stringent glycemic goals may be appropriate for individual patients. Goals should be individualized based on duration of diabetes, age/life expectancy, comorbid conditions, known CVD or advanced microvascular complications, hypoglycemia unawareness, and individual patient considerations. Postprandial glucose may be targeted if A1c goals are not met despite reaching preprandial glucose goals. Postprandial glucose measurements should be made 1–2 h after the beginning of the meal, generally peak levels in patients with diabetes.
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| NICE [18] |
2019 |
For adults with type 2 diabetes managed either by lifestyle and diet, or by lifestyle and diet combined with a single drug not associated with hypoglycemia, support the person to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycemia, support the person to aim for an HbA1c level of 53 mmol/mol (7.0%). In adults with type 2 diabetes, if HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher, reinforce advice about diet, lifestyle, and adherence to drug treatment and support the person to aim for an HbA1c level of 53 mmol/mol (7.0%) and intensify drug treatment.
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| ACC/AHA [29] |
2019 |
HbA1c>6.5% (48 mmol/mol): Consideration of metformin as first line pharmacologic therapy to improve glycemic control and reduce CVD risk (class IIa); dietary counseling regarding key aspects of a healthy heart diet (class I); ≥150 minutes of moderate to vigorous physical activity (class I); aggressive treatment of other CVD risk factors. HbA1c>7.0 (53 mmol/mol) after lifestyle and metformin: if CV risk factors—SGLT-2 inhibitor or GLP-1 receptor agonist to improve glycemic control and CV risk (class IIb); if no CV risk factors—further management of diabetes per primary care provider or endocrinologist.
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