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. 2013 Jan;36(1):84-9.
doi: 10.2337/dc11-2344. Epub 2012 Sep 6.

Public health implications of recommendations to individualize glycemic targets in adults with diabetes

Neda Laiteerapong  1 , Priya M John, Aviva G Nathan, Elbert S Huang
Affiliations

Public health implications of recommendations to individualize glycemic targets in adults with diabetes

Neda Laiteerapong et al. Diabetes Care. 2013 Jan.

Abstract

Objective: To estimate how many U.S. adults with diabetes would be eligible for individualized A1C targets based on 1) the 2012 American Diabetes Association (ADA) guideline and 2) a published approach for individualized target ranges.

Research design and methods: We studied adults with diabetes ≥20 years of age from the National Health and Nutrition Examination Survey 2007-2008 (n = 757). We assigned A1C targets based on duration, age, diabetes-related complications, and comorbid conditions according to 1) the ADA guideline and 2) a strategy by Ismail-Beigi focused on setting target ranges. We estimated the number and proportion of adults with each A1C target and compared individualized targets to measured levels.

Results: Using ADA guideline recommendations, 31% (95% CI 27-34%) of the U.S. adult diabetes population would have recommended A1C targets of <7.0%, and 69% (95% CI 66-73%) would have A1C targets less stringent than <7.0%. Using the Ismail-Beigi strategy, 56% (51-61%) would have an A1C target of ≤7.0%, and 44% (39-49%) would have A1C targets less stringent than <7.0%. If a universal A1C <7.0% target were applied, 47% (41-54%) of adults with diabetes would have inadequate glycemic control; this proportion declined to 30% (26-36%) with the ADA guideline and 31% (27-36%) with the Ismail-Beigi strategy.

Conclusions: Using individualized glycemic targets, about half of U.S. adults with diabetes would have recommended A1C targets of ≥7.0% but one-third would still be considered inadequately controlled. Diabetes research and performance measurement goals will need to be revised in order to encourage the individualization of glycemic targets.

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Figures

Figure 1
Figure 1
Distribution of measured A1C levels in the U.S. adults with the highest and lowest individualized targets. Black bar, ADA: more stringent A1C target (<6.5%); white bar, ADA: less stringent A1C target (<8.0%); black bar with white dots, Ismail-Beigi: target A1C ≤6.5%; white bar with black dots, Ismail-Beigi: target A1C = 7.5–8.5%.
See this image and copyright information in PMC

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