Framework for considering diabetes management goals
| Special considerations | Rationale | A1C | Fasting and premeal blood glucose targets | Glucose 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 |