HbA1c Target Recommendations for Adults with Diabetes

General Target Recommendations

The American College of Physicians recommends an HbA1c target between 7% and 8% for most adults with type 2 diabetes to balance benefits and risks 4
The Institute for Clinical Systems Improvement recommends personalizing goals with patients to achieve glycemic control with an HbA1c between <7% to <8% depending on individual patient factors 1, 2
The Veterans Affairs/Department of Defense guidelines recommend a range of HbA1c 7.0-8.5% for most individuals with established microvascular or macrovascular disease, comorbid conditions, or 5-10 years life expectancy 3, 5

A target HbA1c of <7% may be appropriate for patients with short duration of diabetes, those treated with lifestyle modifications or metformin only, patients with long life expectancy (>10-15 years), those without significant cardiovascular disease, and patients with no history of severe hypoglycemia 4, 5
The VA/DoD suggests a target HbA1c range of 6.0-7.0% for patients with life expectancy greater than 10-15 years and absent or mild microvascular complications, if it can be safely achieved 5

A less stringent HbA1c target (7-8% or higher) is more appropriate for patients with history of severe hypoglycemia, those with advanced microvascular or macrovascular complications, patients with extensive comorbid conditions, those with long-standing diabetes that is difficult to control, patients with limited life expectancy (<10 years), and older adults, particularly those who are frail 1, 2, 4

Targeting HbA1c levels below 7% may increase risk for death, weight gain, hypoglycemia, and other adverse effects in many patients 1, 2
The NICE guideline recommends involving adults with type 2 diabetes in decisions about their individual HbA1c target, considering quality of life impacts 2, 3

For patients with severely elevated HbA1c (>9%), combination therapy options including metformin plus a second agent or insulin should be considered 7
For patients with HbA1c between 7-8%, maintain current therapy if they are at appropriate individualized target 6

Perform HbA1c testing at least twice yearly in patients meeting treatment goals with stable glycemic control 6
Test quarterly in patients whose therapy has changed or who are not meeting glycemic goals 6