New Treatment Guidelines for Diabetes

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Clinical Context

The American Diabetes Association (ADA) has just published its standards of medical care in diabetes for 2018, and of course, it includes a discussion of glycemic targets. For most patients, the ADA is comfortable with a target glycated hemoglobin (HbA1c) level of less than 7%. However, for younger patients without a history of significant hypoglycemia or cardiovascular disease, an HbA1c goal of less than 6.5% may be appropriate. Conversely, more frail adults with a history of severe complications of diabetes and a high risk for hypoglycemia may be treated more effectively to a target HbA1c level of less than 8%.

The target preprandial plasma glucose level should be 80 to 130 mg/dL for most patients, and the peak postprandial glucose level should not exceed 180 mg/dL. Many pharmacologic interventions are available to achieve these targets, but what is the best practice in choosing these agents? A significant section of the current recommendations focuses on this question.

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