Recommendations
- A reasonable A1C goal for many nonpregnant adults is <7% (53 mmol/mol). A
- Providers might reasonably suggest more stringent A1C goals (such as <6.5% [48 mmol/mol]) for selected individual patients if this can be achieved without significant hypoglycemia or other adverse effects of treatment. ...
What is a good glycemic control for diabetics?
Read the latest info. Good glycemic control, as measured by A1C, reduces the risk of diabetes complications. For most people with diabetes, the A1C goal should be <7%.
What is the goal of glucose management?
Glycemic Control: Assessment, Monitoring and Goal Setting. The goal of glucose management is to reduce long-term complications of diabetes. There is strong evidence for the benefits of tight glucose control early in the course of diabetes.
Is the glycemic index useful for controlling blood sugar if you have diabetes?
Some people with diabetes use the glycemic index (GI) as a guide in selecting foods for meal planning. The glycemic index classifies carbohydrate-containing foods according to their potential to raise your blood sugar level.
What is a target blood sugar level for diabetes?
Your health care team may also use the term goal. People who have diabetes have blood sugar targets for different times of the day. Your health care team will recommend a blood sugar target for you. These are typical targets: Before your meal: 80 to 130 mg/dl. Two hours after the start of the meal: Less than 180 mg/dl.
What is glycemic control for adults?
Good glycemic control: average fasting blood glucose of 80–130 mg/dL. Poor glycemic control: average fasting blood glucose of > 130 mg/dL.
What is optimal glycemic control?
Optimal glycemic control was defined as A1c < or =7%, and suboptimal control was defined as A1c >7%. Follow-up was performed at six and 12 months after the index intervention.
What is the recommended fasting blood glucose goal range for individuals with diabetes?
What Is a Healthy Fasting Blood Sugar (Glucose) Level for a Person With Diabetes? According to the American Diabetes Association (ADA) clinical practice recommendations, updated annually, a healthy fasting and before eating a meal blood glucose level should be in the range of 80 – 130 mg/dL.
What is the general A1C goal for most patients with type 2 diabetes?
The goal for most adults with diabetes is an A1C that is less than 7%. If your A1C level is between 5.7 and less than 6.5%, your levels have been in the prediabetes range. If you have an A1C level of 6.5% or higher, your levels were in the diabetes range.
What is the A1C goal for diabetic patients?
The goal for most people with diabetes is 7% or less. However, your personal goal will depend on many things such as your age and any other medical conditions.
What level of A1C requires insulin?
Insulin therapy will often need to be started if the initial fasting plasma glucose is greater than 250 or the HbA1c is greater than 10%.
What is a good blood sugar level for a type 2 diabetes in the morning?
What should your blood sugar be when you wake up? Whenever possible, aim to keep your glucose levels in range between 70 and 130 mg/dL in the morning before you eat breakfast, and between 70 and 180 mg/dL at other times.
What is the goal fasting glucose in a patient with type 2 diabetes?
The goal range is between 70 and 130mg/dl. This 60mg/dl range between 70-130mg/dl accounts for about a 2.1% change in A1c for most type 2 diabetics.
What is the normal blood sugar level for a 70 year old?
Normal ranges of blood sugar levels are between 70 and 130 mg/dL before eating meals. The American Diabetes Association recommends seniors have blood glucose levels of less than 180 mg/dL two hours after eating. Not every senior has the same care needs, which means they don't all need the same type of at-home care.
What are the new guidelines for A1C?
ADA now recommends A1C below 7% or TIR above 70%, and time below range lower than 4% for most adults. In previous years, the Standards of Care included an “A1C Testing” subsection that recommended people with diabetes test their A1C two to four times a year with an A1C target below 7%.
What are the new diabetes guidelines?
Tweet thisThe ADA now recommends that adults who do not have diabetes symptoms should be screened for prediabetes and type 2 diabetes starting at age 35. This change comes after the US Preventive Services Task Force (USPSTF) lowered its recommended screening age from 45 to 35 years in August, 2021.
At what A1C should you start metformin?
Recent guidelines recommend considering use of metformin in patients with prediabetes (fasting plasma glucose 100-125 mg/dL, 2-hr post-load glucose 140-199 mg/dL, or A1C 5.7-6.4%), especially in those who are <60 years old, have a BMI >35 kg/m2, or have a history of gestational diabetes.
What is meant by glycemic control?
Glycemic control remains a delicate balancing act. The diabetic patient is tasked with maintaining euglycemic blood glucose levels, a goal requiring education, decision strategies, volitional control, and the wisdom to avoid hyper- and hypoglycemia, with the latter defined as plasma glucose less than ∼60 mg/dl.
How is glycemic control measured?
Glycated hemoglobin (A1C, hemoglobin A1C, HbA1c), which reflects average levels of blood glucose over the previous two to three months, is the most widely used test to monitor chronic glycemic control. It is used to diagnose diabetes and to monitor the efficacy of treatment.
What is permissive hyperglycemia?
Permissive hyperglycemia (blood glucose target 10–14 mmol/L) effectively decreases the incidence of hypoglycemia among critically ill patients with elevated glycated hemoglobin A1c.
Assessment of Glycemic Control
Two primary techniques are available for health providers and patients to assess the effectiveness of the management plan on glycemic control: patient self-monitoring of blood glucose (SMBG) and A1C. Continuous glucose monitoring (CGM) or interstitial glucose may be a useful adjunct to SMBG in selected patients.
A1C Testing
Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). E
A1C Goals
For glycemic goals in children, please refer to Section 11 “Children and Adolescents.” For glycemic goals in pregnant women, please refer to Section 12 “Management of Diabetes in Pregnancy.”
Hypoglycemia
Individuals at risk for hypoglycemia should be asked about symptomatic and asymptomatic hypoglycemia at each encounter. C
Intercurrent Illness
For further information on management of patients with hyperglycemia in the hospital, please refer to Section 13 “Diabetes Care in the Hospital.”
Assessment of Glycemic Control
Glycemic control is assessed by the A1C measurement, continuous glucose monitoring (CGM), and self-monitoring of blood glucose (SMBG). A1C is the metric used to date in clinical trials demonstrating the benefits of improved glycemic control.
Glycemic Goals
For glycemic goals in older adults, please refer to Section 12, “Older Adults” ( https://doi.org/10.2337/dc21-S012 ). For glycemic goals in children, please refer to Section 13 “Children and Adolescents” ( https://doi.org/10.2337/dc21-S013 ).
Hypoglycemia
6.9 Occurrence and risk for hypoglycemia should be reviewed at every encounter and investigated as indicated. C
Intercurrent Illness
For further information on management of patients with hyperglycemia in the hospital, see Section 15 “Diabetes Care in the Hospital” ( https://doi.org/10.2337/dc21-S015 ).
What is A1C weighted?
A1C is a "weighted" measure of glycemic control over the preceding 120 days. The more recent days contribute a greater percentage to the measure than the distant days. Specifically, the mean level of blood glucose in the 30 days immediately preceding the test contributes approximately 50% of the final result.
What are the two primary measures of glycemic control?
Two primary measures are available for health providers and patients to assess the effectiveness of glycemic control: A1C and patient self-monitoring of blood glucose (SMBG).
What is the purpose of reviewing SMBG data and A1C results with the patient at each diabetes visit?
Review SMBG data and A1C results with the patient at each diabetes visit, and take them into consideration when making therapeutic management decisions.
What is the A1C eAG?
Health care providers can report A1C results to patients using eAG (estimated average glucose). The eAG uses the same units (mg/dL) that are used in home blood glucose measurements. For some patients, the eAG may be easier to understand than the A1C, and useful when discussing patients' glucose goals and results.
Why is tight glucose management important?
The goal of glucose management is to reduce long-term complications of diabetes. There is strong evidence for the benefits of tight glucose control early in the course of diabetes. While intensive glycemic control in newly diagnosed patients is beneficial, tight control in the general diabetes population has not demonstrated the same benefits.
What is the target range for glycemic control?
As shown in the Table below, the Veterans Administration/Department of Defense (VA/DoD) Diabetes Practice Guidelines Working Group recommends these target ranges: from < 7%, 7-8%, and 8-9%.
How often should SMBG be performed?
All insulin-treated patients should perform SMBG. If on multiple daily injections or an insulin pump, SMBG should be performed ≥ 3 times/day. The decision as to whether and how often to prescribe SMBG in non-insulin treated patients should be individualized.
What is the glycemic index?
The glycemic index classifies carbohydrate-containing foods according to their potential to raise your blood sugar level. Foods with a high glycemic index value tend to raise your blood sugar higher and faster than do foods with a lower value. The glycemic index may have some benefits, but may have some problems too. Concerns include:
How to control blood sugar?
Basic principles of healthy eating, portion control and counting carbohydrates are all ways to help you better manage and control your blood sugar. If you're interested in learning more, talk to a registered dietitian. He or she can help you make healthy changes in your eating habits for improved blood sugar control.
Is glycemic index good for diabetes?
Is the glycemic index useful for controlling blood sugar if you have diabetes? Some people with diabetes use the glycemic index (GI) as a guide in selecting foods for meal planning. The glycemic index classifies carbohydrate-containing foods according to their potential to raise your blood sugar level. Foods with a high glycemic index value tend ...
Does a low GI food have a high glycemic index?
Doesn't rank foods based on nutrient content — foods with a low GI ranking may be high in calories, sugar or saturated fat. It can be difficult to follow the glycemic index. For one thing, there's no standard for what is considered low, moderate and high glycemic foods. Packaged foods generally don't list their GI ranking on the label, ...
Does blood sugar include carbohydrates?
Doesn't consider all variables that affect blood sugar, such as how food is prepared or how much is eaten. Doesn't include foods that have low or no carbohydrates and only includes carbohydrate-containing foods.
How can I check my blood sugar?
Use a blood sugar meter (also called a glucometer) or a continuous glucose monitor (CGM) to check your blood sugar. A blood sugar meter measures the amount of sugar in a small sample of blood, usually from your fingertip. A CGM uses a sensor inserted under the skin to measure your blood sugar every few minutes. If you use a CGM, you’ll still need to test daily with a blood sugar meter to make sure your CGM readings are accurate.
What are blood sugar targets?
A blood sugar target is the range you try to reach as much as possible. These are typical targets:
How can I treat low blood sugar?
If you’ve had low blood sugar without feeling or noticing symptoms (hypoglycemia unawareness), you may need to check your blood sugar more often to see if it’s low and treat it. Driving with low blood sugar can be dangerous, so be sure to check your blood sugar before you get behind the wheel.
What causes blood sugar to be high?
Many things can cause high blood sugar (hyperglycemia), including being sick, being stressed, eating more than planned, and not giving yourself enough insulin. Over time, high blood sugar can lead to long-term, serious health problems. Symptoms of high blood sugar include:
What are ketones?
Ketones are a kind of fuel produced when fat is broken down for energy. Your liver starts breaking down fat when there’s not enough insulin in your bloodstream to let blood sugar into your cells.
What is diabetic ketoacidosis?
If you think you may have low blood sugar, check it even if you don’t have symptoms.
How do carbs affect blood sugar?
Carbs in food make your blood sugar levels go higher after you eat them than when you eat proteins or fats. You can still eat carbs if you have diabetes. The amount you can have and stay in your target blood sugar range depends on your age, weight, activity level, and other factors. Counting carbs in foods and drinks is an important tool for managing blood sugar levels. Make sure to talk to your health care team about the best carb goals for you.
What is the recommended A1C for diabetics?
With regard to glycemic targets, these guidelines divide older adults into two categories. For those without other major comorbidities, an A1C goal of 7–7.5% and a fasting glucose target range of 6.5–7.5 mmol/L (117–135 mg/dL) are recommended, whereas for frail older adults and those with multisystem disease, an A1C goal of 7.6–8.5% and a fasting glucose target range of 7.6–9.0 mmol/L (137–162 mg/dL) are recommended to minimize the risk of hypoglycemia and metabolic decompensation.
Why is hypoglycemia a limiting factor?
Hypoglycemia is one of the major limiting factors when trying to achieve recommended levels of glycemic control at any age (11,12). However, older patients have a higher risk of hypoglycemia and poor outcomes due to altered adaptive physiologic responses to low glucose levels (13,14). Hypoglycemia unawareness is also common in older adults and increases the risk of silent hypoglycemia that remains unrecognized (15). For aging patients with diabetes, hypoglycemia also has the potential to precipitate or trigger cardiovascular events, worsen cognitive function, and lead to poor outcomes (16). Other devastating complications of hypoglycemia that lead to decline in quality of life include an increase in falls and fractures, fear of falling, confusion, delirium, and symptoms such as fatigue and dizziness (17).
What is the recommended glycemic target for older adults?
For functionally independent older adults, the IDF recommends an A1C goal of 7–7.5%, whereas for functionally dependent, frail patients or patients with dementia, an A1C goal of 7–8% is recommended. For end-of-life care, IDF recommends avoiding a specific A1C goal and focusing instead on avoiding symptomatic hyperglycemia.
What are the risks of diabetics?
Older adults with diabetes are at higher risk for both acute and chronic microvascular and macrovascular complications from the disease, including major lower-extremity amputations, myocardial infarctions, visual impairments, and end-stage renal disease, compared to any other age-group (3). Patients who are >75 years of age are more likely to develop complications, have higher rates of death from hyperglycemic crises and have an increased rate of emergency department visits for hypoglycemia compared to those who are <75 years of age (1).
Is A1C a gold standard?
A1C remains the gold standard test to assess long-term glycemic control in the management of diabetes . It is now also used to diagnose diabetes (18). However, as shown in Table 5, several factors commonly seen in older adults can falsely raise or lower A1C (19). Aging itself is associated with an elevation in A1C (20).
Does diabetes affect cognitive function?
Both aging and diabetes increase the risk of certain comorbidities (geriatric syndromes) including cognitive dysfunction, depression, functional disabilities, falls and fractures, polypharmacy, chronic pain, and urinary incontinence (10). It is important to recognize these conditions because they can interfere with patients’ ability to perform diabetes self-care. If clinicians are not aware of these coexisting conditions, they may prescribe treatment that is too complex for a patient with cognitive dysfunction or miss an opportunity to treat depression that can lead to nonadherence to medications and social isolation. Polypharmacy can increase the risk of drug interactions, and pain and incontinence directly affect quality of life. Vision and hearing impairments can also lead to social isolation, errors in treatment, traumatic falls, and disability. Table 4details how the presence of geriatric syndromes can interfere with patients’ ability to perform self-care tasks and offers strategies for optimizing care in such situations.
Can elderly people manage diabetes?
Some elderly people with diabetes are high functioning and medically stable, can perform self-care, and may or may not need caregivers. However, for others who are unable to follow instructions and manage their own medication regimen, diabetes management can be tricky and dangerous. In addition, the aging population with diabetes also has a higher risk of other conditions (termed “geriatric syndromes”) that include cognitive dysfunction, depression, physical disability, pain, polypharmacy, and urinary incontinence. The goals of diabetes management must differ for older adults based on the presence or absence of these comorbidities, as well as on the patients’ living situation and available resources. Another challenge in this population is a higher frequency of acute illnesses and frequent changes in overall health, which can affect glucose control and lead to decline in cognitive functioning and physical status. In such cases, it is important to adjust treatment goals as needed. Most of the discussion in the remainder of this article pertains to community-living older adults.
What is the A1C test?
The A1C test measures a patient’s average glycemic levels over the past two to three months. Hemoglobin A1C in people without diabetes is between 4 – 5.6%, which means that 4 – 5.6% of a non-diabetic person’s hemoglobin has non-enzymatically attached glucose. In a chronically uncontrolled diabetic patient, the percentage of hemoglobin that has non-enzymatically attached glucose is much higher. The test is a way of assessing glycemic control at initial diagnosis and ongoing continuity of care.
What are the A1C goals?
The American Diabetes Association recommends targets for A1C and self-monitored blood glucose levels, depending on the patient’s individual profile: 1 A reasonable hemoglobin A1C for many non-pregnant diabetic patients in general < 7%. 2 A more stringent hemoglobin A1C goal ( <6.5% ) might be reasonable for some patients (e.g. those with long life expectancy, short duration of diabetes, no significant CVD), if significant hypoglycemia or other side effects can be avoided, but this is based on weaker evidence. 3 A less stringent A1C (< 8%) may be considered in patients with histories of severe hypoglycemia, limited life expectancies, advanced diabetes complications, extensive comorbid conditions, and in those with longstanding diabetes in whom the general goal is difficult to attain despite multidisciplinary efforts. 4 Pre-meal capillary glucose of 90 – 130 mg/dL. 5 Post-meal (1 – 2 hours) capillary glucose of <180 mg/dL.