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HbA1c and Glucose Targets May Be Unaligned

A new analysis of continuous glucose monitoring suggests that the current A1c and glucose level recommendations for patients with diabetes are not in sync…. 

Currently, the A1c goal for patients with diabetes is ≤ 6.5% or < 7% depending on several factors. Since A1c is only measured every 3 months, day-to-day monitoring of blood glucose is important for diabetes patients in order to reach that goal. In other words, diabetes patients have self-monitored blood glucose targets that are formed by expert opinion in order to help the patient reach their A1c target.

In a recent study, Nancy Wei, MD, from the Diabetes Center at Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues, determined average fasting, post-prandial, and bedtime self-monitored blood glucose values associated with specific A1c levels. The 12 week study compared continuous glucose monitoring with a Medtronic Minimed monitor (baseline and 3 times at 4 week intervals) to glucose levels assessed every 5 minutes, regular finger-stick measures, and monthly A1c values.

The results from the data representing 237 type 1 diabetes patients and 141 type 2 diabetes patients suggest currently recommended fasting blood glucose targets are actually lower than needed to achieve the target A1c values and some post-prandial targets may be too high. Post-prandial blood glucose values in the study were 144 mg/dL for patients with A1c levels between 5.5% and 6.49% and 164 mg/dL for those in the 6.5% to 6.99% range.

Dr. Wei commented on the results of the study saying, "The consequences of using the previously published, nonempirical data may include pushing patients harder to achieve lower fasting levels than are actually required. Considering the safety concerns surrounding hypoglycemia…the current recommended glucose targets emphasizing lower fasting blood glucose and higher post-prandial blood glucose should be reevaluated."

Practice Pearls:
  • Current A1c and blood glucose level goals are not aligned.
  • Data from a new study suggests that currently recommended fasting blood glucose targets are generally lower than needed to achieve the target A1c values and some post-prandial targets may be too high.

Diabetes Care. Published online February 10, 2014. Abstract Glucose Targets and HbA1c Goals Aren’t in Synch, Study Finds