PMID- 33082551
OWN - NLM
STAT- MEDLINE
DCOM- 20210122
LR  - 20221207
IS  - 1759-5037 (Electronic)
IS  - 1759-5029 (Linking)
VI  - 16
IP  - 12
DP  - 2020 Dec
TI  - The trials and tribulations of determining HbA(1c) targets for diabetes mellitus.
PG  - 717-730
LID - 10.1038/s41574-020-00425-6 [doi]
AB  - Glycated haemoglobin (HbA(1c)) is considered the gold standard for predicting 
      glycaemia-associated risks for the microvascular and macrovascular complications 
      of diabetes mellitus over 5-10 years. The value of HbA(1c) in the care of 
      patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) 
      is unassailable, yet HbA(1c) targets remain contentious. Guidelines from diabetes 
      care organizations recommend conflicting HbA(1c) targets - generally between 6.5% 
      and 8%. However, all such organizations advocate for individualization of HbA(1c) 
      targets, leaving both health-care providers and their patients confused about 
      what HbA(1c) target is appropriate in an individual patient. In this Review, we 
      outline the landmark T1DM and T2DM trials that informed the current guidelines, 
      we discuss the evidence that drives individualized HbA(1c) targets, we examine 
      the limitations of HbA(1c), and we consider alternatives for monitoring glycaemic 
      control. Ultimately, in synthesizing this literature, we argue for an HbA(1c) 
      target of <7% for most individuals, but emphasize the importance of helping 
      patients determine their own personal goals and determinants of quality of life 
      that are independent of a particular glycaemic target. We also recognize that as 
      newer technologies and anti-hyperglycaemic therapies emerge, glycaemic targets 
      will continue to evolve.
FAU - Klein, Klara R
AU  - Klein KR
AUID- ORCID: 0000-0002-5894-9054
AD  - Division of Endocrinology and Metabolism, University of North Carolina School of 
      Medicine, Chapel Hill, NC, USA. klara_klein@med.unc.edu.
FAU - Buse, John B
AU  - Buse JB
AD  - Division of Endocrinology and Metabolism, University of North Carolina School of 
      Medicine, Chapel Hill, NC, USA.
LA  - eng
GR  - UL1 TR002489/TR/NCATS NIH HHS/United States
GR  - P30 DK124723/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20201020
PL  - England
TA  - Nat Rev Endocrinol
JT  - Nature reviews. Endocrinology
JID - 101500078
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Animals
MH  - Diabetes Mellitus/blood/drug therapy/*metabolism
MH  - Diabetes Mellitus, Type 1/blood/drug therapy/metabolism
MH  - Diabetes Mellitus, Type 2/blood/drug therapy/metabolism
MH  - Glycated Hemoglobin/analysis/*metabolism
MH  - Goals
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
EDAT- 2020/10/22 06:00
MHDA- 2021/01/23 06:00
CRDT- 2020/10/21 05:59
PHST- 2020/09/16 00:00 [accepted]
PHST- 2020/10/22 06:00 [pubmed]
PHST- 2021/01/23 06:00 [medline]
PHST- 2020/10/21 05:59 [entrez]
AID - 10.1038/s41574-020-00425-6 [pii]
AID - 10.1038/s41574-020-00425-6 [doi]
PST - ppublish
SO  - Nat Rev Endocrinol. 2020 Dec;16(12):717-730. doi: 10.1038/s41574-020-00425-6. 
      Epub 2020 Oct 20.