6. Glycemic Targets: Standards of Medical Care in Diabetes—2020
Article Figures & Tables
Figures
- Figure 6.1
Sample Ambulatory Glucose Profile (AGP) report. Adapted from Battelino et al. (17).
- Figure 6.2
Depicted are patient and disease factors used to determine optimal A1C targets. Characteristics and predicaments toward the left justify more stringent efforts to lower A1C; those toward the right suggest less stringent efforts. A1C 7% = 53 mmol/mol. Adapted with permission from Inzucchi et al. (47).
Tables
- Table 6.1
Estimated average glucose (eAG)
A1C (%) mg/dL* mmol/L 5 97 (76–120) 5.4 (4.2–6.7) 6 126 (100–152) 7.0 (5.5–8.5) 7 154 (123–185) 8.6 (6.8–10.3) 8 183 (147–217) 10.2 (8.1–12.1) 9 212 (170–249) 11.8 (9.4–13.9) 10 240 (193–282) 13.4 (10.7–15.7) 11 269 (217–314) 14.9 (12.0–17.5) 12 298 (240–347) 16.5 (13.3–19.3) Data in parentheses are 95% CI. A calculator for converting A1C results into eAG, in either mg/dL or mmol/L, is available at professional.diabetes.org/eAG.
↵* These estimates are based on ADAG data of ∼2,700 glucose measurements over 3 months per A1C measurement in 507 adults with type 1, type 2, or no diabetes. The correlation between A1C and average glucose was 0.92 (6,7). Adapted from Nathan et al. (6).
- Table 6.2
Standardized continuous glucose monitoring (CGM) metrics for clinical care
1. Number of days CGM device is worn (recommend 14 days)
2. Percentage of time CGM device is active (recommend 70% of data from 14 days)
3. Mean glucose
4. Glucose management indicator (GMI)
5. Glycemic variability (%CV) target ≤36%*
6. Time above range (TAR): % of readings and time >250 mg/dL (>13.9 mmol/L)
Level 2 7. Time above range (TAR): % of readings and time 181–250 mg/dL (10.1–13.9 mmol/L)
Level 1 8. Time in range (TIR): % of readings and time 70–180 mg/dL (3.9–10.0 mmol/L)
In range 9. Time below range (TBR): % of readings and time 54–69 mg/dL (3.0–3.8 mmol/L)
Level 1 10. Time below range (TBR): % of readings and time <54 mg/dL (<3.0 mmol/L)
Level 2 CGM, continuous glucose monitoring; CV, coefficient of variation.
↵*Some studies suggest that lower %CV targets (<33%) provide additional protection against hypoglycemia for those receiving insulin or sulfonylureas. Adapted from Battelino et al. (17).
- Table 6.3
Summary of glycemic recommendations for many nonpregnant adults with diabetes
A1C <7.0% (53 mmol/mol)* Preprandial capillary plasma glucose 80–130 mg/dL* (4.4–7.2 mmol/L) Peak postprandial capillary plasma glucose† <180 mg/dL* (10.0 mmol/L) ↵* More or less stringent glycemic goals may be appropriate for individual patients. Goals should be individualized based on duration of diabetes, age/life expectancy, comorbid conditions, known CVD or advanced microvascular complications, hypoglycemia unawareness, and individual patient considerations.
↵†Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals. Postprandial glucose measurements should be made 1–2 h after the beginning of the meal, generally peak levels in patients with diabetes.
- Table 6.4
Classification of hypoglycemia
Glycemic criteria/description Level 1 Glucose <70 mg/dL (3.9 mmol/L) and ≥54 mg/dL (3.0 mmol/L) Level 2 Glucose <54 mg/dL (3.0 mmol/L) Level 3 A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia Reprinted from Agiostratidou et al. (51).
In this Issue
