This document discusses glycemic goals for different groups of diabetics according to guidelines from the ADA, AACE, and IDF. It outlines recommended levels for fasting glucose, post-prandial glucose, and A1C for the general diabetic population as well as for children, pregnant women, those with gestational diabetes, and hospitalized patients. The guidelines note the need to individualize goals based on factors like duration of diabetes, age, and comorbidities. Strict glycemic control is associated with lower risks of microvascular complications and slowing progression of existing complications, as well as long-term reductions in macrovascular complications for young diabetics.

1. Glycemic Goals in Diabetics
Dr. Jagjit Khosla
Junior Resident,
Endocrinology,
GTBH

2. Glycemic goals in diabetics
ADA
Guidelines
AACE
Guidelines
IDF Guidelines
Fasting
Glucose
70-130 mg/dL <110 mg/dL <115 mg/dL
Post Prandial
Glucose
<180 mg/dL
(Peak)
<140 mg/dL <160 mg/dL
HBA1C < 7% ≤ 6.5% < 7%

3. Individualising glycemic goals
• ADA Criteria for assessing individual goals
– Duration of diabetes
– Age/ Life expectancy
– Comorbid conditions
– Known CVS disease or advanced microvascular
complications
– Hypoglycaemic unawareness
Reference : ADA Guidelines 2013

4. Individualising glycemic goals
• HBA1C < 7%
– Nonpregnant adults
• HBA1C < 6.5% (More stringent)
– Short duration of diabetes
– Long life expectancy
– No significant CVD risk
• HBA1C < 8% (Less stringent)
– History of Severe hypoglycemia
– Limited life expectancy
– Advanced micro- or macro-vascular complications
– Extensive comorbid conditions
– Long standing diabetes
Reference : ADA Guidelines 2013

5. Glycemic goals – Diabetic Children
• Hypoglycemic unawareness upto 6-7 years
• Risk for permanent cognitive impairment after
severe hypoglycemia in children below 5 yrs
Long-term
health benefits
Adverse effects
on development
Reference : ADA Guidelines 2013

6. Glycemic goals – Diabetic Children
Before meal Blood
Sugar
Bedtime/Overnight
Blood Sugar
HBA1C
Toddler & Preschool
(0-6 years)
100-180 mg/dL 110-200 mg/dL < 8.5%
School Age
(6-12 years)
90-180 mg/dL 100-180 mg/dL < 8%
Adolescents & Young
(13-19 years)
90-130 mg/dL 90-150 mg/dL < 7.5%
Reference : ADA Guidelines 2013

7. Glycemic goals in GDM
Pre-prandial Blood Sugar ≤ 95 mg/dL
1-hr Post meal Blood Sugar ≤ 140 mg/dL
2-hr Post meal Blood Sugar ≤ 120 mg/dL
OR
+
Reference : Metzger BE et al, Summary and recommendations of the Fifth International
Workshop – Conference on GDM. Diabetes Care 2007, 30(Suppl.2):S251-S260)

8. Glycemic goals in Diabetics
who become pregnant
Premeal, Bedtime & Overnight B. S. 60 – 99 mg/dL
Peak Post-prandial B. S. 100 – 129 mg/dL
HBA1C < 6%
Reference : Kitzmiller JL et al, Managing pre-existing diabetes for pregnancy : Summary of
evidence & consensus recommendations for care. Diabetes Care 2008; 31:1060-1079

9. Glycemic goals in Hospital setting
• Critically ill patients
– Goal – 140-180 mg/dL
– If hypoglycemia can be avoided, 110-140 mg/dL
• Non-critically ill patients
– Premeal B.S. goal <140 mg/dL
– Random B.S. goal <180 mg/dL
– Less stringent goals in pts with severe comorbidities.
Reference : ADA Guidelines 2013

10. Health benefits of strict glycemic goals
• UKPDS (UK Prospective Diabetes Study) – Type 2 DM
• DCCT (Diabetes Control & Complications Trial) – Type 1 DM
1. Lower risk of microvascular complications
2. Slows the progression of existing complications
3. Long-term reduction in macrovascular complications (esp.young
diabetics)

11. Thank you