Table 2

Framework for considering diabetes management goals

Special considerationsRationaleA1CFasting and premeal blood glucose targetsGlucose monitoring
Community-dwelling patients at skilled nursing facility for short rehabilitation• Rehabilitation potential
• Goal to discharge home
• Need optimal glycemic control after recent acute illness• Avoid relying on A1C due to recent acute illness
• Follow current glucose trends
• 100–200 mg/dL• Monitoring frequency based on complexity of regimen
Patients residing in LTC• Limited life expectancy
• Frequent changes in health impacting glucose levels
• Limited benefits of intensive glycemic control
• Focus needs to be on better quality of life
• <8.5% (69 mmol/mol)
• Use caution in interpreting A1C due to presence of many conditions that interfere with A1C levels
• 100–200 mg/dL• Monitoring frequency based on complexity of regimen and risk of hypoglycemia
Patients at end of life• Avoid invasive diagnostic or therapeutic procedures that have little benefit• No benefit of glycemic control except avoiding symptomatic hyperglycemia• No role of A1C• Avoid symptomatic hyperglycemia• Monitoring periodically only to avoid symptomatic hyperglycemia