Public Health Implications of Recommendations to Individualize Glycemic Targets inAdultsWithDiabetes

OBJECTIVEdTo estimate how many U.S. adults with diabetes would be eligible for individ-ualized A1C targets based on 1) the 2012 American Diabetes Association (ADA) guideline and 2) a published approach for individualized target ranges. RESEARCH DESIGNANDMETHODSdWe studied adults with diabetes$20 years of age from the National Health and Nutrition Examination Survey 2007–2008 (n = 757). We assigned A1C targets based on duration, age, diabetes-related complications, and comorbid conditions according to 1) the ADA guideline and 2) a strategy by Ismail-Beigi focused on setting target ranges. We estimated the number and proportion of adults with each A1C target and compared individualized targets to measured levels. RESULTSdUsing ADA guideline recommendations, 31 % (95 % CI 27–34%) of the U.S. adult diabetes population would have recommended A1C targets of,7.0%, and 69 % (95 % CI 66– 73%) would have A1C targets less stringent than,7.0%. Using the Ismail-Beigi strategy, 56% (51–61%) would have an A1C target of#7.0%, and 44 % (39–49%) would have A1C targets less stringent than,7.0%. If a universal A1C,7.0 % target were applied, 47 % (41–54%) of adults with diabetes would have inadequate glycemic control; this proportion declined to 30 % (26