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
• 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).