The nurse takes a blood sample from a diabetic patient to measure his glycosylated hemoglobin (Hgb A1C). The patient's goal is to achieve a level lower than

7%.

Explanation

• The American Diabetic Association recommends an A1C of 7% or below for most nonpregnant adults to reduce the microvascular complications of diabetes.

• The ADA recommends a more stringent goal of <6.5% for selected individuals with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects.

• Less stringent goals (such as <8%) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced vascular complications, extensive comorbid conditions, or long-standing diabetes with poor management despite education and effective insulin treatment. This is on a case by case basis.

• The American Association of Clinical Endocrinologists recommends an A1C goal of 6.5% or less.

• 5.5% is too low.

• 7.5% and 8% would not be the goal unless the patient was very poorly managed and had comorbidities (which were not described in this question).

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