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HbA1c targets in type 2 diabetes: guidelines and evidence


Type 2 diabetes is defined by chronic hyperglycaemia, decreased insulin secretion and increased insulin resistance and is often associated with overweight or obesity, hypertension and dyslipidaemia.1 Aims of treatment include minimising long-term complications (e.g. cardiovascular disease, blindness, chronic kidney disease, premature mortality) and avoiding unwanted effects of treatment (e.g. severe hypoglycaemia, weight gain).1 Publication of the United Kingdom Prospective Diabetes Study (UKPDS) 33 study in 1998 suggested that ‘intensive blood glucose control’ to lower the glycated haemoglobin (HbA1c) in people with type 2 diabetes reduced microvascular disease but not macrovascular complications.2 The UKPDS 34 study in overweight patients found that metformin produced less of a reduction in HbA1c but reduced cardiovascular complications and death.3 More recently, further trials have examined the impact of intensive glycaemic control and have produced conflicting results.1,4–11 Here we examine the evidence and guideline recommendations for HbA1c targets; glycaemic control for acutely unwell patients and targets in pregnancy will not be covered.

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