What Should the Hemoglobin A1c Level Goal be in Diabetics?

An increased hemoglobin A1c level in patients with diabetes mellitus is associated with an increased incidence of ischemic stroke, increased severity of coronary artery disease, and an increased severity of peripheral arterial disease. Results from 5 prospective clinical trials which randomized diabetics to intensive blood glucose control or to standard blood glucose control and one retrospective observational study of 26,673 diabetics are discussed. The 5 clinical trials were the United Kingdom Prospective Diabetes Study, the Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications Study, the Action to Control Cardiovascular Risk in Diabetes Study, the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modifies-Release Controlled Evaluation Study, and the Veterans Affairs Diabetes Trial. Severe hypoglycemia may be associated with cardiovascular events and mortality. Recommendations from the 2007 scientific statement from the American Heart Association and the American Diabetes Association, the 2011 American Heart Association/American College of Cardiology Foundation secondary prevention guidelines in patients with coronary and other atherosclerotic vascular disease, the 2013 American Diabetes Association guidelines, and the 2013 American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus are also discussed.