Hemoglobin A1C under 7 %

Recommendation 6.3a, grade A, sets an A1C goal under 7 percent as appropriate for many nonpregnant adults without severe hypoglycemia or hypoglycemia that affects health or quality of life. Table 6.3 pairs it with a fasting or preprandial glucose of 80 to 130 mg/dL and a peak after-meal glucose under 180 mg/dL, and its first footnote says more or less stringent goals may be appropriate for certain individuals. The Standards say the figure that sets those goals "is not designed to be applied rigidly."

When the goal is tighter. Recommendation 6.4: lower goals, for example under 6.5 percent, "may be appropriate for individuals with diabetes with good health and function and low treatment risks (e.g., hypoglycemia) and burdens." The narrative adds the conditions: the tighter goal must be reachable safely, with an acceptable burden of therapy, and with enough life expectancy to collect the benefit.

When it is looser. Recommendation 6.5: less stringent goals "may be appropriate for individuals with significant cognitive and/or functional limitations, frailty, or severe comorbidities or where the harms of treatment, including hypoglycemia, are greater than the benefits." The number the Standards attach in their narrative is an A1C up to 8 percent, for people with complex health status or limited life expectancy. Severe or frequent hypoglycemia is described as "an absolute indication for the modification of treatment plans, including setting higher glycemic goals" when the plan uses insulin or insulin secretagogues. Recommendations 6.6 and 6.7 go further: deintensify hypoglycemia-causing medications, or switch to a class with lower hypoglycemia risk, for anyone at high risk of lows, and deintensify any medication whose harms or burdens outweigh its benefits.

How the goal is tracked. Recommendation 6.2: at least twice a year, and about every 3 months when the goal is not being met or treatment has just changed. Recommendation 6.3b sets the continuous glucose monitoring equivalent, time in range above 70 percent, and 6.3c caps time below 70 mg/dL at 4 percent (1 percent for older adults). Recommendation 6.9 asks that a goal be set explicitly during consultations, and 6.8 that it be reassessed against the individualization criteria as health changes.