Recommendations

l  Glycemic status should be assessed at least twice a year using HbA1c and/or suitable continuous glucose monitoring (CGM) parameters. Individuals who are not fulfilling treatment objectives, have frequent or severe hypoglycemia or hyperglycemia, have fluctuating health status, or are growing and developing in adolescence should be assessed more regularly (every three months). (Good practice statement)

l  Glycemic status should be assessed at least quarterly and as needed in people whose therapy has recently changed and/or who are not achieving their glycemic targets. (Good practice statement)

l  An HbA1c target for many nonpregnant adults of <7% without significant hypoglycemia is recommended. (strong recommendation)

l  Time in range is associated with the risk of microvascular complications and can be used for assessment of glycemic control. Additionally, time below range and time above range are useful parameters for the evaluation of the treatment plan.                        (Conditional recommendation).

l  If using an ambulatory glucose profile/glucose management indicator to assess glycemia, a parallel goal for many nonpregnant adults is TIR >70% with time below range <4% and time <54 mg/dL <1%. For those with frailty or at high risk of hypoglycemia, a goal of >50% TIR with <1% time below range is recommended. (Conditional recommendation).

l  On the basis of health care professional judgment and patient preference, achievement of lower HbA1c levels than the goal of 7% may be acceptable and even beneficial if it can be achieved safely without significant hypoglycemia or other adverse effects of treatment.  (Strong recommendation)

l  Less stringent HbA1c targets (such as <8% may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits. (Strong recommendation).

l  Healthcare professionals should consider deintensification of therapy if appropriate to reduce the risk of hypoglycemia in patients with inappropriate stringent HbA1c targets.  (Strong recommendation).