Recommendations: Glycemic Goals in Adults (1)

Glycemic control is fundamental to the management of diabetes; recommendations for glycemic goals in nonpregnant adults1 are reviewed on three slides Slide 1 of 3 Lowering A1C to below or around 7% has been shown to reduce microvascular complications of diabetes, and if implemented soon after the diagnosis of diabetes is associated with long-term reduction in macrovascular disease; therefore, a reasonable A1C goal for many nonpregnant adults is <7% (B) The DCCT,2 a prospective RCT of intensive versus standard glycemic control in patients with relatively recently diagnosed type 1 diabetes, showed definitively that improved glycemic control is associated with significantly decreased rates of microvascular (retinopathy and nephropathy) and neuropathic complications Follow-up of the DCCT cohorts in the Epidemiology of Diabetes Interventions and Complications (EDIC) study3,4 demonstrated persistence of these microvascular benefits in previously intensively treated subjects, even though their glycemic control approximated that of previous standard arm subjects during follow-up39Reference American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(suppl 1):S19. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-986. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl JMed 2000;342:381-389. Martin CL, Albers J, Herman WH, et al for the DCCT/EDIC Research Group. Neuropathy among the diabetes control and complications trial cohort 8 years after trial completion. Diabetes Care 2006;29:340-344.