Glycemic Targets in Diabetes

2016 ADA Guideline Recommendations
Types of Diabetes Mellitus
Main Diabetes Page
Diabetes type I
Diabetes type II
Gestational Diabetes Mellitus
2016 ADA Standard of Medical Care Guideline Recommendations
Strategies for Improving Care
Classification and Diagnosis of Diabetes
Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Prevention or Delay of Type II Diabetes
Glycemic Targets
Obesity Management for Treatment of Type II Diabetes
Approaches to Glycemic Treatment
Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]

2016 ADA Standards of Medical Care in Diabetes Guidelines

"1. When prescribed as part of a broader educational context, self-monitoring of blood glucose (SMBG) results may help to guide treatment decisions and/or self-management for patients using less frequent insulin injections B or non- insulin therapies. (Level of Evidence: E)"

"2. When prescribing SMBG, ensure that patients receive ongoing instruction and regular evaluation of SMBG technique, SMBG results, and their ability to use SMBG data to adjust therapy. (Level of Evidence: E)"

"3. Most patients on intensive insulin regimens (multiple-dose insulin or insulin pump therapy) should consider SMBG prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to critical tasks such as driving. (Level of Evidence: B)"

"4. 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. (Level of Evidence: A)"

"5. Although the evidence for A1C lowering is less strong in children, teens, and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device. (Level of Evidence: B)"

"6. CGM may be a supplemental tool to SMBG in those with hypoglycemia un- awareness and/or frequent hypoglycemic episodes. (Level of Evidence: C)"

"7. Given variable adherence to CGM, assess individual readiness for continuing CGM use prior to prescribing. (Level of Evidence: E)"

"8. When prescribing CGM, robust diabetes education, training, and support are required for optimal CGM implementation and ongoing use. (Level of Evidence: E)"

"9. People who have been successfully using CGM should have continued access after they turn 65 years of age. (Level of Evidence: E)"

A1C TESTING

"1. Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). (Level of Evidence: E)"

"2. Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. (Level of Evidence: E)"

"3. Point-of-care testing for A1C provides the opportunity for more timely treatment changes (Level of Evidence: E)"

A1C GOALS

"1. A reasonable A1C goal for many nonpregnant adults is ,7% (53 mmol/mol) . (Level of Evidence: A)"

"2. Providers might reasonably sug- gest more stringent A1C goals (such as ,6.5% [48 mmol/mol]) for selected individual patients if this can be achieved without signif- icant hypoglycemia or other adverse effects of treatment. Appropriate patients might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expec- tancy, or no significant cardiovascular disease. (Level of Evidence: C)"

"3. Less stringent A1C goals (such as ,8% [64 mmol/mol]) may be ap- propriate for patients with a his- tory of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comor- bid conditions, or long-standing diabetes in whom the general goal is difficult to attain despite diabetes self-management educa- tion, appropriate glucose monitor- ing, and effective doses of multiple glucose-lowering agents including insulin. (Level of Evidence: B)"