Targets for Glycemic Control

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

S. Ali Imran MBBS, FRCP(Edin), FRCPC Rémi Rabasa-Lhoret MD, PhD Stuart Ross MB, ChB, FRACP, FRCPC

  • Key Messages
  • Recommendations
  • Figures
  • Highlights
  • Full Text
  • References

Key Messages

  • Optimal glycemic control is fundamental to the management of diabetes.
  • Both fasting and postprandial plasma glucose levels correlate with the risk of complications and contribute to the measured glycated hemoglobin (A1C) value.
  • Glycemic targets should be individualized based on the individual’s age, duration of diabetes, risk of severe hypoglycemia, presence or absence of cardiovascular disease and life expectancy.

Highlights of Revisions

  • New recommendation better defines the scenarios in which one can consider less stringent glycated hemoglobin (A1C) targets (7.1% to 8.5% in most cases).

Figure 1
Recommended targets for glycemic control.


  1. 1.Glycemic targets should be individualized based on age, duration of diabetes, risk of severe hypoglycemia, presence or absence of cardiovascular disease, and life expectancy [Grade D, Consensus].
  2. 2.Therapy in most individuals with type 1 or type 2 diabetes should be targeted to achieve an A1C ≤7.0% in order to reduce the risk of microvascular [Grade A, Level 1A (1,2) ] and, if implemented early in the course of disease, macrovascular complications [Grade B, Level 3 (3,4)].
  3. 3.An A1C ≤6.5% may be targeted in some patients with type 2 diabetes to further lower the risk of nephropathy [Grade A, Level 1 (5) ] and retinopathy [Grade A, Level 1 (6) , but this must be balanced against the risk of hypoglycemia [Grade A, Level 1 (5)].
  4. 4.Less stringent A1C targets (7.1%–8.5% in most cases) may be appropriate in patients with type 1 or type 2 diabetes with any of the following [Grade D, Consensus]:
    • a) Limited life expectancy
    • b) High level of functional dependency
    • c) Extensive coronary artery disease at high risk of ischemic events
    • d) Multiple comorbidities
    • e) History of recurrent severe hypoglycemia
    • f) Hypoglycemia unawareness
    • g) Longstanding diabetes for whom it is difficult to achieve an A1C ≤7.0% despite effective doses of multiple antihyperglycemic agents, including intensified basal-bolus insulin therapy
  • 5.In order to achieve an A1C ≤7.0%, people with diabetes should aim for:
    • FPG or preprandial PG target of 4.0–7.0 mmol/L and a 2-hour PPG target of 5.0–10.0 mmol/L [Grade B, Level 2 (2) for type 1; Grade B, Level 2 (1,7) for type 2 diabetes].
    • If an A1C target ≤7.0% cannot be achieved with a PPG target of 5.0–10.0 mmol/L, further PPG lowering to 5.0–8.0 mmol/L should be achieved [Grade D, Consensus, for type 1 diabetes; Grade D, Level 4 (8,9) for type 2 diabetes].

A1C, glycated hemoglobin; BG, blood glucose; FPG, fasting plasma glucose; PG, plasma glucose; PPG, postprandial plasma glucose.


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Reproduced with permission from Canadian Journal of Diabetes © 2013 Canadian Diabetes Association. To cite this article, please refer to For citation.

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