HbA1c Goals for Adults with Diabetes Mellitus

General HbA1c Target Recommendations

A target HbA1c of <7% is appropriate for many non-pregnant adults with diabetes, as this level has been shown to reduce microvascular complications and, when implemented soon after diagnosis, is associated with long-term reduction in macrovascular disease 1, 2
The American Diabetes Association (ADA) supports this <7% target as a reasonable goal for many adults with diabetes 1
The American College of Physicians (ACP) recommends an HbA1c target between 7% and 8% for most adults to balance benefits and risks 3

For adults with short duration of diabetes, treatment with lifestyle modifications or metformin only, long life expectancy, absence of significant cardiovascular disease, and no history of severe hypoglycemia, a more stringent goal of <6.5% might be appropriate 1, 2, 5

For adults with a history of severe hypoglycemia, advanced microvascular or macrovascular complications, extensive comorbid conditions, long-standing diabetes, or limited life expectancy, a less stringent goal of <8% may be more appropriate 1, 2, 5

The American Diabetes Association recommends performing A1C testing at least twice yearly in patients meeting treatment goals with stable glycemic control, and quarterly in patients whose therapy has changed or who are not meeting glycemic goals 6
Point-of-care testing for A1C provides opportunity for more timely treatment adjustments 2

The American Diabetes Association recommends initiating metformin therapy along with lifestyle interventions at the time of type 2 diabetes diagnosis, unless metformin is contraindicated 2
For patients not meeting goals, the American Diabetes Association suggests considering therapy intensification with additional agents 2