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When HbA1c is used to evaluate glycemic control, what patient characteristic should be considered?
The American College of Physicians also recommends higher glycemic targets for patients hospitalized in surgical or medical intensive care units. For patients who require insulin therapy, blood glucose targets of 140 to 200 mg/dL are recommended, because targets of <140 mg/dL are associated with increased risk of harm. Ethnicity should also
be considered when HbA1c is used to assess glycemic control. Analyses from the DURABLE trial showed that among patients with HbA1c levels between 7.0% and 9.0%, patients of Asian, Hispanic, and African descent had HbA1c levels that were 0.2% to
0.5% higher than whites for a given blood glucose level
When HbA1c is used to evaluate glycemic control, what patient characteristic should be considered?
The American College of Physicians also recommends higher glycemic targets for patients hospitalized in surgical or medical intensive care units. For patients who require insulin therapy, blood glucose targets of 140 to 200 mg/dL are recommended, because targets of <140 mg/dL are associated with increased risk of harm. Ethnicity should also
be considered when HbA1c is used to assess glycemic control. Analyses from the DURABLE trial showed that among patients with HbA1c levels between 7.0% and 9.0%, patients of Asian, Hispanic, and African descent had HbA1c levels that were 0.2% to
0.5% higher than whites for a given blood glucose level
Early and aggressive glycemic control is the primary goal of management for both T1DM and T2DM. HbA1c should be maintained as close to normal as possible without inducing hypoglycemia. Reductions in HbA1c are associated with a lower risk of diabetic complications. Specifically, in one observational study,
for every 1% reduction in HbA1c, the risk of diabetes-‐related death was reduced by 21%, the risk of myocardial infarction by 14%, and the risk of microvascular complications by 37%. That said, various organizations have established target glycemic levels for nonpregnant adults (Table 1), although
individualized treatment goals for T2DM are recommended. Tighter glycemic control may be appropriate for some individuals, especially those with short duration of diabetes, long life expectancy, and no
cardiovascular disease.
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