Optimal Hemoglobin A_1c Targets: Guidance from the ACP

The American College of Physicians’ Clinical Efficacy Assessment Subcommittee reviewed the strengths and weaknesses of guidelines from nine generalist and specialist organizations, using a standard appraisal instrument, to develop recommendations regarding glycemic control goals for patients with type 2 diabetes. On the basis of the guideline review, they recommend the following standards for patient care:

• The goal for glycemic control should be as low as feasible without undue risk for adverse events or unacceptable patient burden; a hemoglobin A_1c value of <7% was deemed a reasonable goal for many patients.

• The goal should be individualized based on risk for microvascular complications versus complications of tight control, comorbidity, lif…