The goal of T2DM therapy is to reestablish normoglycemia and avoid both the excesses of hyperglycemia and the dangers associated with hypoglycemia. For patients with T2DM, the goals for a patient-centered approach to glycemic treatment are evidence based and are predicated on data from landmark trials showing reductions in the microvascular complications of diabetes mellitus associated with glycated hemoglobin (HbA
1c) levels of less than 7%; these levels generally correspond to premeal or fasting glucose levels of 70 mg/dL to 130 mg/dL and postprandial glucose levels of less than 180 mg/dL.
11,12 In the past 2 years, however, most major organizations have recognized the need for an individualized approach to both treatment goals and treatment options, weighing both the risks and the benefits to the patient. In 2012, the American Diabetes Association (ADA), in conjunction with the European Association for the Study of Diabetes (EASD), issued a position statement for the management of hyperglycemia that emphasizes a patient-centered approach, with the avoidance of hypoglycemia considered a primary tenet, particularly in at-risk patients.
12 The ADA and the EASD suggest less stringent goals for HbA
1c levels (7.5% to 8.0%) for patients with a history of severe hypoglycemia, a limited life expectancy, advanced complications, or extensive comorbid conditions, or for those who have difficulty attaining glycemic control,
11,12 drawing on lessons from studies by the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial,
13 the Veterans Affairs Diabetes Trial (VADT),
14 and the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial.
15 However, for younger patients or for patients with disease of short duration, a long life expectancy, and no significant cardiovascular disease, HbA
1c goals closer to normal (eg, 6.0% to 6.5%) are recommended.
11,12 The American Association of Clinical Endocrinologists concurs with the individualization of treatment goals and has led the way to the development of a comprehensive care plan for patients with T2DM.
16 Paying attention to cardiovascular risk factors (eg, high blood pressure, high cholesterol levels) is important for all patients with T2DM, as is focusing on glucose control.