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1.
2. When HbA1c is used to evaluate glycemic control,
what patient characteristic should be considered?
The
American
College
of
Physicians
also
recommends
higher
glycemic
targets
for
patients
hospitalized
in
surgical
or
medical
intensive
care
units.
For
patients
who
require
insulin
therapy,
blood
glucose
targets
of
140
to
200
mg/dL
are
recommended,
because
targets
of
<140
mg/dL
are
associated
with
increased
risk
of
harm.
Ethnicity
should
also
be
considered
when
HbA1c
is
used
to
assess
glycemic
control.
Analyses
from
the
DURABLE
trial
showed
that
among
patients
with
HbA1c
levels
between
7.0%
and
9.0%,
patients
of
Asian,
Hispanic,
and
African
descent
had
HbA1c
levels
that
were
0.2%
to
0.5%
higher
than
whites
for
a
given
blood
glucose
level
When HbA1c is used to evaluate glycemic control,
what patient characteristic should be considered?
The
American
College
of
Physicians
also
recommends
higher
glycemic
targets
for
patients
hospitalized
in
surgical
or
medical
intensive
care
units.
For
patients
who
require
insulin
therapy,
blood
glucose
targets
of
140
to
200
mg/dL
are
recommended,
because
targets
of
<140
mg/dL
are
associated
with
increased
risk
of
harm.
Ethnicity
should
also
be
considered
when
HbA1c
is
used
to
assess
glycemic
control.
Analyses
from
the
DURABLE
trial
showed
that
among
patients
with
HbA1c
levels
between
7.0%
and
9.0%,
patients
of
Asian,
Hispanic,
and
African
descent
had
HbA1c
levels
that
were
0.2%
to
0.5%
higher
than
whites
for
a
given
blood
glucose
level
Early
and
aggressive
glycemic
control
is
the
primary
goal
of
management
for
both
T1DM
and
T2DM.
HbA1c
should
be
maintained
as
close
to
normal
as
possible
without
inducing
hypoglycemia.
Reductions
in
HbA1c
are
associated
with
a
lower
risk
of
diabetic
complications.
Specifically,
in
one
observational
study,
for
every
1%
reduction
in
HbA1c,
the
risk
of
diabetes-‐related
death
was
reduced
by
21%,
the
risk
of
myocardial
infarction
by
14%,
and
the
risk
of
microvascular
complications
by
37%.
That
said,
various
organizations
have
established
target
glycemic
levels
for
nonpregnant
adults
(Table
1),
although
individualized
treatment
goals
for
T2DM
are
recommended.
Tighter
glycemic
control
may
be
appropriate
for
some
individuals,
especially
those
with
short
duration
of
diabetes,
long
life
expectancy,
and
no
cardiovascular
disease.
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