<strong>2008</strong> CLINICAL PRACTICE GUIDELINES S30 of significant atherosclerosis, albuminuria, left ventricular hypertrophy or at least 2 additional risk factors for CVD (obesity, hypertension, dyslipidemia or current status as a smoker).At baseline, mean age was 62.2 years, median duration of diabetes was 10 years and mean A1C was 8.3%. One of the major arms of the trial was to determine whether an intensive PG-lowering approach aimed at achieving A1C levels
RECOMMENDATIONS 1. Glycemic targets must be individualized; however, therapy in most individuals with type 1 or type 2 diabetes should be targeted to achieve an A1C ≤7.0% in order to reduce the risk of microvascular [Grade A, Level 1A (1-4)] and, in individuals with type 1 diabetes, macrovascular complications [Grade C, Level 3 (5)]. 2. A target A1C of ≤6.5% may be considered in some patients with type 2 diabetes to further lower the risk of nephropathy [Grade A Level 1A (4)], but this must be balanced against the risk of hypoglycemia [Grade A Level 1A (4,5)] and increased mortality in patients who are at significantly elevated risk of cardiovascular disease [Grade A Level 1A (4)]. 3. In order to achieve A1C of ≤7.0%, people with diabetes should aim for: • An FPG or preprandial PG target of 4.0 to 7.0 mmol/L [Grade B, Level 2 (1), for type 1; Grade B, Level 2 (2,3), for type 2 diabetes]; and • A 2-hour postprandial PG target of 5.0 to 10.0 mmol/L [Grade B, Level 2 (1), for type 1 diabetes; Grade B, Level 2 (2,3), for type 2 diabetes]. If A1C targets cannot be achieved with a postprandial target of 5.0 to 10.0 mmol/L, further postprandial BG lowering to 5.0 to 8.0 mmol/L can be considered [Grade D, Consensus, for type 1 diabetes; Grade D, Level 4 (18,19), for type 2 diabetes]. OTHER RELEVANT GUIDELINES Monitoring Glycemic Control, p. S32 Hypoglycemia, p. S62 Type 1 <strong>Diabetes</strong> in Children and Adolescents, p. S150 Type 2 <strong>Diabetes</strong> in Children and Adolescents, p. S162 <strong>Diabetes</strong> and Pregnancy, p. S168 <strong>Diabetes</strong> in the Elderly, p. S181 REFERENCES 1. 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Risk factors for myocardial infarction and death in newly detected NIDDM: the <strong>Diabetes</strong> Intervention Study, 11-year follow-up. Diabetologia. 1996;39:1577-1583. 18. Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients. <strong>Diabetes</strong> Care. 2003;26:881-885. 19. Woerle HHJ, Neumann C, Zschau S, et al. Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes. Importance of postprandial glycemia to achieve target HbA1c levels. Diab Res Clin Pract. 2007;77:280-285. 20. Monnier L, Colette C, Dunseath GJ, et al.The loss of postprandial glycemic control precedes stepwise deterioration of fasting with worsening diabetes. <strong>Diabetes</strong> Care. 2007;30:263-269. S31 MANAGEMENT
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