Less-stringent A1C goals (7.5 - 8.0%) may be acceptable in certain individuals with type 2 diabetes. Which factor(s) support less stringent goals?
Answer: D: All of the above
In 2008, the American Diabetes Association, the American Heart Association and the American College of Cardiology, based upon analysis of findings from the ACCORD, ADVANCE and VADT studies, released a joint position statement providing clarified guidance for determining individualized A1C targets that reiterated the importance of considering these factors when determining appropriate individualized glycemic targets. Some factors favor more stringent efforts to lower A1C, while others favor less stringent efforts (Table 1).
Table 1. Patient Characteristics that Inform More or Less Stringent A1C Targets
MORE STRINGENT EFFORTS
(A1C equal to or less than 7%)
Highly motivated - Excellent diabetes self-care (Adherent to treatment plan) - Relatively healthy - Low risk for hypoglycemia and other adverse effects - Newly diagnosed - Long life expectancy -Few/mild comorbidities - Absent/few/mild vascular complications - Has support/resources
LESS STRINGENT EFFORTS
(A1C equal to or less than 7.5 to 8.0%)
Low motivation - Poor diabetes self-care - Poor adherence to treatment plan - Frail or with additional conditions - High risk for hypoglycemia and other adverse effects - Long-standing disease duration - Short life expectancy- Many/severe comorbidities - Many/severe vascular complications - Limited support/resources
Standards of Medical Care in Diabetes—2016 Abridged for Primary Care Providers: American Diabetes Association: Clinical Diabetes 2016 Jan; 34(1): 3-21. http://dx.doi.org/10.2337/diaclin.34.1.3