Editorial

Goals for HbA1c Need To Be Individualized Based on Clinical Judgment, Instead of Third Party Recommendations

Authors: David S.H. Bell, MD

Abstract

Fowler et al1 in this issue of the SMJ recommend a comprehensive approach to achieving a desirable HbA1c by controlling both postprandial and fasting glucose levels and are careful to emphasize that, in achieving a desirable HbA1c, hypoglycemia should be avoided. Very often, in patients utilizing insulin and sulfonlyureas, even with careful monitoring, the desired HbA1c cannot be achieved because of hypoglycemia. In the current medical environment where the HbA1c is used to judge the quality of healthcare delivery and may even result in financial gain or loss, “treating to goal” may not always be in the best interest of the patient. Furthermore, the use of the HbA1c as a “quality control” often makes endocrinologists and diabetologists who are seeing the more difficult to manage diabetic patient appear to be providing inferior care. Therefore, the “one size fits all” concept of the HbA1c is entirely inappropriate and goals for the HbA1c need to be individualized and based on clinical judgment.

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