HbA1c targets should be personalized in type 2 diabetes
Elizabeth L. Tung, M.D., from the University of Chicago, and colleagues developed an updated guidance statement relating to optimal glycemic targets for non-pregnant adults with type 2 diabetes.
The authors note that HbA1c goals should be personalized for patients with type 2 diabetes based on discussions of the benefits and harms of pharmacotherapy, patient preferences, health, and life expectancy; the burden of treatment; and costs associated with care. In most patients with type 2 diabetes, the target should be an HbA1c level between 7 and 8 percent. For patients with type 2 diabetes and HbA1c levels <6.5 percent, deintensification of pharmacologic therapy should be considered. For patients with a life expectancy of less than 10 years due to advanced age, nursing home residence, or end-stage chronic conditions, type 2 diabetes should be treated to minimize hyperglycemia symptoms and HbA1c targets should be avoided.
"High-quality, long-term randomized trials have improved knowledge of glycemic control in type 2 diabetes, but important gaps remain," the authors write. "Despite consensus that personalizing goals for glycemic control is important, little evidence exists for how to personalize goals consistently."
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