title: Public health implications of recommendations to individualize glycemic targets in adults with diabetes.
abstract: OBJECTIVE
  To estimate how many U.S. adults with diabetes would be eligible for individualized A1C targets based on 1) the 2012 American Diabetes Association (ADA) guideline and 2) a published approach for individualized target ranges.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Using 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% (26-36%) with the ADA guideline and 31% (27-36%) with the Ismail-Beigi strategy.
  
  
  CONCLUSIONS
  Using individualized glycemic targets, about half of U.S. adults with diabetes would have recommended A1C targets of ≥7.0% but one-third would still be considered inadequately controlled. Diabetes research and performance measurement goals will need to be revised in order to encourage the individualization of glycemic targets.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA. nlaiteer@medicine.bsd.uchicago.edu
authors.forename: Neda
authors.initials: N
authors.lastname: Laiteerapong
authors.forename: Priya M
authors.initials: PM
authors.lastname: John
authors.forename: Aviva G
authors.initials: AG
authors.lastname: Nathan
authors.forename: Elbert S
authors.initials: ES
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011634:Public Health / Q000592:standards*; D014481:United States; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin