Faramarz Ismail-Beigi, MD, PhD; Etie Moghissi, MD; Margaret Tiktin, NP; Irl B. Hirsch, MD; Silvio E. Inzucchi, MD; Saul Genuth, MD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2380.
Requests for Single Reprints: Faramarz Ismail-Beigi, MD, PhD, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44122-4951; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Ismail-Beigi and Genuth and Ms. Tiktin: Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44122-4951.
Dr. Moghissi: 4644 Lincoln Boulevard, Suite 409, Marina Del Rey, CA 90292.
Dr. Hirsch: University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98915-6176.
Dr. Inzucchi: Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520.
Author Contributions: Conception and design: F. Ismail-Beigi, E. Moghissi, M. Tiktin, S.E. Inzucchi.
Analysis and interpretation of the data: F. Ismail-Beigi, E. Moghissi, I.B. Hirsch, S.E. Inzucchi, S. Genuth.
Drafting of the article: F. Ismail-Beigi, E. Moghissi, M. Tiktin, I.B. Hirsch, S. Genuth.
Critical revision of the article for important intellectual content: F. Ismail-Beigi, E. Moghissi, M. Tiktin, I.B. Hirsch, S.E. Inzucchi, S. Genuth.
Final approval of the article: F. Ismail-Beigi, E. Moghissi, M. Tiktin, I.B. Hirsch, S.E. Inzucchi, S. Genuth.
Collection and assembly of data: F. Ismail-Beigi, E. Moghissi.
Ismail-Beigi F, Moghissi E, Tiktin M, Hirsch IB, Inzucchi SE, Genuth S. Individualizing Glycemic Targets in Type 2 Diabetes Mellitus: Implications of Recent Clinical Trials. Ann Intern Med. 2011;154:554-559. doi: 10.7326/0003-4819-154-8-201104190-00007
Download citation file:
Published: Ann Intern Med. 2011;154(8):554-559.
One of the first steps in the management of patients with type 2 diabetes mellitus is setting glycemic goals. Professional organizations advise setting specific hemoglobin A1c (HbA1c) targets for patients, and individualization of these goals has more recently been emphasized. However, the operational meaning of glycemic goals, and specific methods for individualizing them, have not been well-described. Choosing a specific HbA1c target range for a given patient requires taking several factors into consideration, including an assessment of the patient's risk for hyperglycemia-related complications versus the risks of therapy, all in the context of the overall clinical setting. Comorbid conditions, psychological status, capacity for self-care, economic considerations, and family and social support systems also play a key role in the intensity of therapy. The individualization of HbA1c targets has gained more traction after recent clinical trials in older patients with established type 2 diabetes mellitus failed to show a benefit from intensive glucose-lowering therapy on cardiovascular disease (CVD) outcomes. The limited available evidence suggests that near-normal glycemic targets should be the standard for younger patients with relatively recent onset of type 2 diabetes mellitus and little or no micro- or macrovascular complications, with the aim of preventing complications over the many years of life. However, somewhat higher targets should be considered for older patients with long-standing type 2 diabetes mellitus and evidence of CVD (or multiple CVD risk factors). This review explores these issues further and proposes a framework for considering an appropriate and safe HbA1c target range for each patient.
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Cardiology, Endocrine and Metabolism, Diabetes, Coronary Risk Factors, Prevention/Screening.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only