The goal A1c is based on an individualized approach. If you have a young woman who is pregnant with diabetes, the goal A1c is very strict at 6.0.

Generally, my goal would be <7, however, for patients who are elderly, are brittle diabetics, have a short term life expectancy, or struggle with hypoglycemia my goals tend to be high at trying to keep it <8.

More intensive therapy is not always associated with better outcomes.

The ACCORD trial looked at effect of intensive treatment of hyperglycemia on microvascular outcomes in type 2 diabetes in 77 clinical sites in the US. The trial included those w/DMII, A1c >7.5, and either cardiovascular disease vs. >/= 2 CVD risk factors. Participants were randomized to either intensive glycemic control (A1c <6) vs. standard (7-7.9). The intensive therapy arm had to be stopped before trial ended due to higher mortality. Intensive therapy did not reduce the risk of advanced measures of microvascular outcomes, but delayed the onset of albuminuria and some measures of eye complications and neuropathy.

There was also a large retrospective study performed in the UK looking at pts age >50 with DMII. The review assessed survival as a function of A1c. They found that the all cause mortality and cardiac events was higher in those with in the strict A1c decile (A1c 6.4) and those with high A1c (A1c 10.5) decile and the lowest hazard ratio at A1c 7.5.

Therefore, I take an individualized approach in discussing what target A1c goals are with each patient and when they are not at target what underlying factors may be contributing to it.

I work as a consultant in longterm care and The majority of my patients are DM2 and over age 75. Since an HGA1C of 7 equates to an average blood sugar or 170, I try to keep the noninsulin dependent patients below 7 on meds but I am very concerned about those taking insulin and developing hypoglycemia. If they can keep their 2 hour postprandial BS under 200 and their fasting blood sugars 125 to 130, I see fewer problems with hypoglycemia causing falls and confusion. Most of these people have had DM for many years and are used to the feeling of slightly elevated BS. It is more important to treat the patient than his numbers. If they are able to participate in activities, enjoy life and not experience problems with the micro/macrovascular problems from diabetes, I prefer to try to get them to eat healthy, stay hydrated, participate in activities and exercise rather that worry about their blood sugars all day.

I rarely gets to the A1C goals for majority of my patients because of difficulty of patients' compliance, changing or modifying their lifestyle period

I chose the mediations proven to reduce Macro and Microvascular complications of diabetes (reduce CV risk and renal protective) since all the medicines lower A1c.

Ideally, 50% would be great. However, my patient population is low income, many with limited education so explaining medication compliance, importance of taking blood sugars and compliance/affordability of best food options is a difficult task. Many have transportation issues so participating in group education activities is often futile as well.

Probably no better than 25%; our area is low income, hi unemployment (or seasonal work) - so meds issues and coverage preclude good control - I use samples all that I can to keep HbA1C below 8%

I strive for a Hba1c of or less to reduce risk of cv events and long term complications of retinopathy neuropathy and nephropathy and would alter that plan if pt was a brittle diabetic or elderly where I would strive for 7 percent without risk for becoming hypoglycemic

Because my patients in a community clinic are all indigent, it's a real challenge to get to goal of <7.0% without use of GLP-1 or SGLT2 inhibitors, which are still incredible expensive. We depend on high-dose metformin, sulfonylureas, patient education, and in some cases, when they qualify, we can get Invokana through medical assistance.

An A1C less than 6.5 is ideal.

About 30%, Compliant patients and new onset or prediabetic patients without complication

Hba1c of 7% or less is just a number and is not an exam score that one needs to get to pass the exam as this deals with management of a diabetic patient in a holisitic way , A good diabetic control is not only overall good hyperglycemic control but should also take in to consideration the prevention of hypoglycemia . So aiming for patients on Insulin to have it less than 7% it is invariably going to come at the cost of hypoglycemia of some degree and that needs to be kept in mind ,A relatively newly diagnosed Type 2 Diabetic with good beta cell function on one or two meds it is quite realistic to get it less than 7 % with out hypoglycemia but as the disease progresses it become less realistic and generally strive to get it between 7-7.5 % Managing comorbid factors of Dyslipidemia , HTN , Obesity and other CV risk factos is very important in preventing adverse CV outcomes than just to get it less than 7 % . Diabetes is a life long pathological process and even in the best compliant patients some degress of complacency is going to come in from time to time and numbers are going to go off ,Commercial payors give the credit for HEDIS measures of Hba1c less 8 and the Medicare less than 9 % and which is quite acheivable in a compliant patient ! So it is the overall management of the diabetic pt in all respect rather than just focus on the Hba1c obsessively !

Aim for <7% or lower if costs and side effects do not limit.

target for A1c should ALWAYS BE INDUVIDUALIZED according to patient's comorbidities and hypoglycemia awareness/unawareness condition; I see comments from some providers here that their target is 6.5% regardless of patient's condition; this is NOT what the major guidelines ( ADA/EASD/Endocrine Society) recommend! what it is recommended is that we should aim for individualized targets depending on patient's comorbidities and to AVOID symptomatic /asymptomatic hypoglycemia

Aim for A1c<6.5 regardless of Age

Also about 50 percent at goal.

Aim for A1C of 6.5 to 7; at times lower for young patients; A1C goal for older patient higher, especially if prone to hypoglycemia.

In most of my patients I will aim for an A1C of but in older patients over the age of 76 and pending their other comorbidities, I may aim for A1C of 7 -7.5 due to the risk of hypoglycemia and high risk of falls.

We always try to have the A1C below 7. But could be flexible depending on other health factors. About 20% have a goal of 7 or less.

A1c is only part of the therapy. Most literature, including the ADVANCe trial is now showing targeting lower A1C’s does not affect mortality and might actually be more harmful as hypoglycemia can occur with lower targets. It does reduce diabetic Nephro patchy however by 20%. We are slowly learning that higher A-1 C‘s are acceptable, somewhere in the range of 7-7.5.

Probably 20-25% below 7%. In general younger pts. aim for that goal and older with co-morbidities around 7-7.5%

the ADVANCE trial has demonstrated in over 10,000 patients with type 2 diabetes, that an intensive strategy with conventional agents can achieve mean A1C levels of 6.5% safely with no increase in mortality and has no significant effect in reducing macrovascular disease, but reduces diabetic nephropathy by ∼20%

About 25% of my patients reached A1c goal of <7, being that most of them are elderly and at risk for hypoglycemia, also if they have severe CHD or other comorbidities, I tend to be flexible with their A1C

Aim for a target of 6.5% This allows for a "cushion" to work towards

I try my patients to have a1c < 7, about 40-50 % reach that goal , older patients age > 70 , I accept higher a1c > 7.5

A1C < 7.0 preferably 6.5. If 70 - 80 yo will allow A1C to correspond with age. Also important to use GLP1 and SGLT2i in as many cases as possible. Not just about A1C number.

I usually aim for alc of 6.5 to 7; at times lower for young patients; alc goal can be relaxed for older patients, especially if prone to hypoglycemia

A1c is only part of the therapy. Most literature is now showing targeting lower A1C’s might actually be more harmful as hypoglycemia can occur with lower targets. We are slowly learning that higher A-1 C‘s are acceptable, somewhere in the range of 7.5.

In most patients I will aim for an A1C of but in older patients I may allow the A1C love 7 even to 7.5 due to the risk of hypoglycemia and subsequent falls risk. It is a clinical judgment but in most patients older than 70-75 is where the A1C above 7 may be applied. The use of CGM has made a significant improvement in the management of DM.

probably in the neighborhood of <20%

Focusing only on A1c means you might miss other areas of improvement like exercise, eating whole foods, balancing stress. Of course you can set targets but you also need to look at how the person gets to that goal. Medication alone will not allow for long term management.

The A1C is only part of the picture. It does help in managing patients over time.

For me Life expectancy for that particular patient is the most important factor in determining A1C goal and this is determined by age and determinant is patient preference and insurance coverage-some patients refuse injections and most will not be compliant if cost to them is high.

A1C of less than 7 is a goal you try to achieve and sometimes lower depending on comorbidities without causing the patient to become hypoglycemic. You want to prescribe the most appropriate medication for each case such as semaglutide, but insurance coverage is a factor. Pts usually will gravitate towards medications that insurance plans will approve.

Hba1c of 7% or less is just a number and is not an exam score that one needs to get to pass the exam as this deals with management of a diabetic patient in a holisitic way , A good diabetic control is not only overall good hyperglycemic control but should also take in to consideration the prevention of hypoglycemia . So aiming for patients on Insulin to have it less than 7% it is invariably going to come at the cost of hypoglycemia of some degree and that needs to be kept in mind ,A relatively newly diagnosed Type 2 Diabetic with good beta cell function on one or two meds it is quite realistic to get it less than 7 % with out hypoglycemia but as the disease progresses it become less realistic and generally strive to get it between 7-7.5 % Managing comorbid factors of Dyslipidemia , HTN , Obesity and other CV risk factos is very important in preventing adverse CV outcomes than just to get it less than 7 % . Diabetes is a life long pathological process and even in the best compliant patients some degress of complacency is going to come in from time to time and numbers are going to go off ,Commercial payors give the credit for HEDIS measures of Hba1c less 8 and the Medicare less than 9 % and which is quite acheivable in a compliant patient ! So it is the overall management of the diabetic pt in all respect rather than just focus on the Hba1c obsessively !

What success stories come to mind when managing patient A1C goals? Please feel free to share advice.

Aim less than 7.0 but lower if easy to get to without added costs or lows. Longer duration may be a barrier for less than 7 given likelihood of insulin/lows. Comorbidties often do not change management but keep away for low with underlying CHD. This pertains to age as is can be challenging to treat nocturnal lows. Patient preference is key whether a patient is willing to take an injection. Costs remain the most important.

I agree with a targeted A1C below 7% unless a patient is over the age of 75. One must consider comorbidities, patient motivation and social situation. It stress the benefits of a CGM and work very hard to get CGM's covered in my patients

As others have said it is always a balance between hypoglycemia and hyperglycemia.
- In someone who can easily achieve an A1c <7% with meds that don't cause lows, the lower A1c the better, our goal might be low 6s even.
- In someone on intensive insulin therapy who can keep blood sugars tight without having many lows (generally patients with type 2 or some patients with type 1 who just aren't very labile, may have some residual beta cell function) we can aim % but I would note that there is no data supporting A1c < 6.5% for DM1, probably due to the risk of lows.
- In your more typical patient on intensive insulin therapy, A1c goal is probably less important than time in range, average BG by CGM, and % low. These are more the parameters I focus on in the majority of my patients aiming for TIR > 70%, time in low < 3% (varies depending on the patient), and average BG by CGM ~150-160.

As a cardiac NP, HgA1c control is very important in secondary prevention. We monitor HgA1c annual in patients with CAD and aim for 7% or less.

I aim for less than 7% in younger, healthier type 2 diabetics. I always tell them, l always tell them lower is better. With type 1, its a different story. most are prone to hypoglycemic episodes, so prefer to have them 7-8. Older patients area also a greater risk for hypoglycemia, falls and injury, so I usually prefer 7-8, especially is they use insulin. you always have to take patient preference into account. Just because I order it does not mean they will comply. It sometimes requires negotiation with the patient.

Depends on the patient age. If patient younger than 70 i aim for A1c 6.5 if older higher. We know from subgroup analysis in clinical trials that prs with A1c 6-6.5 have way less complications than the group with a1c .

I will usually stratify pts (either by age/ comorbidities/ life expectancy) So my goal for younger healthy pts will be a 6% for example, whereas for my 80-90 yr olds, it might be an 8-8.5% specially if they are prone to hypoglycemia. If my patients have sugars of >250 all day, then no question insulin is the first thing I will be thinking of. If a patient ismorbidly obese and cannot stop eating, then I will add GLP1 agents. If a patient has chronic kidney disease mild-moderate and microalbuminuria, I will consider SGLT2 prob dapagliflozin,. Also if they have CHF I might add on dapagliflozin. If they had a CABG or angioplasty, then it will probably be empagliflozin. It really needs to be individualized

An Ha1c of less than 7 is ideal depending on patient compliance of course. You have to consider the comorbidities, and pt. compliance with taking blood sugars, diet. Diabetes care needs an entire team to work with the patient, so it just depends on alot of different variables and how many medications the patient is already taking for the diabetes, maybe there is nothing else that can be added.

I am for a targeted A1C of below 7% it is all dependent on their average daily blood glucose readings, their symptoms, as well as their lifestyle and dietary habits