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Guidelines published by the American Diabetic Association suggest glycemic goals as the achievement of hemoglobin A1c levels at less than 7%, fasting glucose levels of 70-130 milligrams per deciliter, and an after meal glucose level of less than 180 milligrams per deciliter.
A1c levels <7%
Initial therapy: lifestyle + metformin
Rapid transition to add new medications, as needed
Early addition of insulin, as needed
A1c levels <6.5%
Initial therapy: dependent on A1c level
Monitor and advance therapy as need q2-3 mo

While the concept is similar, there is a lack of consensus on these recommendations by the American Association of Clinical Endocrinologists, which has issued guidelines with lower hemoglobin A1c goals at less than or equal to 6.5%. Both recommend lifestyle changes and rapid advancement of medication therapy if glycemic control is not achieved.



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