What is the target plasma glucose level (fasting/preprandial/postprandial/HbA1C) for proper glycemic control in adult with diabetes, any consensus?
Targets for Glycemic Control
Recommendations
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].
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)].
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)].
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
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].
http://guidelines.diabetes.ca/executivesummary/ch8
One might consider that a meta-analysis review of well-controlled clinical trials encompassing over 34,000 patients shows that reduction of hyperglycemia by intensive therapy in type 2 diabetic patients simply has no effect on microvascuar disease (neuropathy, retinopathy, nephropathy). The importance to complications of polyols, protein glycation, AGE, etc. is seriously questioned. See Boussageon et al (2011). Worse, the risk of cardiac events is increased. The concern for serious hypoglycemic episodes is well placed.
I can answer on HbA1C targets in patients with diabetic retinopathy (DR).
In case of mild Dr A1C ≤6.5% may be targeted in patients , and ≤7.0% and ≤7.5% in case of moderate and severe DR respectively.
ali has answered very nicely the targets are not unifarm and they must be individualized. these targets will also depends on the drugs being used if the drugs are not producing hyoglycemia then targets can be very closed to physiological limits by large the ada has already decided that the fasting blood sugar must be kept between 80 to 130 mg percent. moreever we must focus on glucose variability which probably makes the complications more complicated
meal-by-meal fasting nutrient levels (low BG 76.6 ± 3.7 mg/dL) prior to the next meal suppressed fattening/insulin resistance. This pattern has been termed the Initial Hunger Meal Pattern (IHMP). Ignoring these sensations contributes to increase obesity and diabetes in children. Asthma, autism, birth defects, dyslexia, attention deficit-hyperactivity disorder, schizophrenia have increased in the last half century.
Would go by the pragmatic approach based on individual factors and in parallel a target HbA1C The younger the subject - and particularly if planning a pregnancy (which is my field) I would go for the more strict approach Hope this helps
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