Good Control of Type 2 Diabetes According to HbA1c

General HbA1c Targets

For most non-pregnant adults with type 2 diabetes, an HbA1c target of less than 7% is considered good control to reduce the risk of microvascular and macrovascular complications 1, 2, 3
The American College of Physicians recommends an HbA1c target range of 7% to 8% for most adults with type 2 diabetes 4, 5
This target should be as low as feasible without causing undue risk of adverse events or placing an unacceptable burden on patients 2, 4

More stringent targets (HbA1c <6.5%) may be appropriate for patients who are newly diagnosed with diabetes, managed with lifestyle modifications or metformin alone, at low risk for hypoglycemia, younger with few comorbidities, or have longer life expectancy (>10 years) 4, 5
Standard targets (HbA1c <7%) are appropriate for most adults with type 2 diabetes and provide a reasonable balance between reducing complications and avoiding adverse effects 1, 2, 3, 4
Less stringent targets (HbA1c <8%) are more appropriate for patients who are older or frail, have limited life expectancy (<5 years), have history of severe hypoglycemia, have advanced diabetes complications, have multiple comorbidities, or are at high risk for adverse effects from tight control 3, 5, 4

The Veterans Health Administration, Institute for Clinical Systems Improvement, and Scottish Intercollegiate Guidelines Network support standard targets (HbA1c <7%) for most adults with type 2 diabetes 1, 2, 3
Regular monitoring of HbA1c (every 3 months until targets achieved, then every 6 months) is recommended 6
Treatment decisions should involve patients and consider their preferences and ability to manage their regimen 2, 5
Setting overly aggressive targets for elderly patients or those with multiple comorbidities should be avoided 5
Failing to adjust targets as patient circumstances change (e.g., development of new comorbidities, aging) should be avoided 6
Overlooking the increased risk of hypoglycemia with intensive control, especially in patients with kidney impairment, should be avoided 5, 6
Focusing solely on HbA1c without considering the patient's quality of life and treatment burden should be avoided 5

An HbA1c level of 7.3% is associated with increased risk of microvascular complications such as nephropathy and retinopathy compared to tighter control, as reported by the American Journal of Kidney Diseases 7
The ADVANCE study showed that patients with an achieved HbA1c of 7.3% had higher rates of microvascular events than those with tighter control (≤6.5%), highlighting the importance of treatment adjustment to improve glycemic control 7
Improving control from 7.3% may particularly benefit patients without existing microvascular disease, according to the American Journal of Kidney Diseases 7