A1C Target: When a Less Stringent Goal May be Appropriate

A reasonable A1C goal for many nonpregnant adults is <7%. For some patients, however, a less stringent goal may be appropriate.

An A1C goal of 8% may be appropriate for which patient(s)?

A. An 80-year old woman with longstanding diabetes, cardiovascular disease, and one prior multifocal stroke.
B. A 23-year-old man with Down syndrome whose type I diabetes was diagnosed at age 12 and whose disease has not been optimally controlled despite insertion of an insulin pump.
C. A 50-year-old with alcoholism, chronic pancreatitis, hepatic cirrhosis, portal hypertension, and esophageal varices.
D. B and C
E. All of the above
F. None of the above

Answer: E (All of the above)

ADA's Recommendations for Glycemic Goals in Adults  (page s19)

Less stringent A1C goals (such as <8%) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, and those with long-standing diabetes in whom the general goal is difficult to attain despite DSME, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin.