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The page below is a sample from the LabCE course Diabetes: Diagnosis, Laboratory Testing, and the Current American Diabetes Association Guidelines (2018). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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ADA Targets for Monitoring Glycemic Control (Hb A1c)

The ADA's latest guidelines (2018) indicate that one of the criteria for screening to help diagnose diabetes is a Hb A1C level of ≥ 6.5%. Moreover, the ADA indicates that the glycemic target for nonpregnant adults with diabetes is < 7.0% and lowering A1C below or around 7.0% has been shown to reduce microvascular complications and macrovascular disease. Therefore, a Hb A1C level that is < 7.0% indicates glycemic control for most adults with diabetes.
The ADA also issues caution on the limitations of the A1C test. Because of the variability in the measurement, clinicians should exercise judgment when using A1C as sole basis for assessing glycemic control. The A1C can give skewed results in people with certain genetic traits that alter the molecules in their red blood cells. The ADA emphasizes that healthcare providers need to be aware of these limitations, to use the correct type of A1C test, and to consider alternate diagnostic tests (fasting plasma glucose test or oral glucose tolerance test) if there is disagreement between A1C and blood glucose levels.
ADA recommendations for A1C goals:
  • For many nonpregnant adults the reasonable goal is an A1C of < 7.0%.
  • Providers may suggest more stringent A1C goals, such as < 6.5%, for selected individuals if the goal can be achieved without significant hypoglycemia or other adverse effects.
  • Less stringent A1C goals, such as < 8.0%, may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, or other conditions that may make the goal difficult to achieve.
  • Providers might recommend even lower Hb A1C goals than the general goal of < 7.0% for some patients (if this can be achieved without significant hypoglycemia or other adverse effects). This includes patients who have a short duration of diabetes (eg, gestational diabetes), long life expectancy, and no significant cardiovascular disease.
  • Less stringent Hb A1C goals than the general goal of < 7.0% may also be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, and those individuals with longstanding diabetes who are not able to consistently achieve the general goal of < 7.0%.

Sources: Diabetes management guidelines (2016). National Diabetes Education Initiative web site. Available at: http://www.ndei.org/ADA-diabetes-management-gudelines-glycemic-targets-A1C-PG.aspx. Accessed April 4, 2018.
ADA Standards of Care (2018), available at http://diabetesed.net/wp-content/uploads/2017/12/2018-ADA-Standards-of-Care.pdf. Accessed April 4, 2018.