Current glycemic targets from the American Diabetes Association (ADA) (Table 1) include a target A1c of <7%. However, it should be noted that this recommendation is a general target and the goal for the individual patient is as close to normal as possible (A1c of < 6%) without significant hypoglycemia. Indeed, to obtain an A1c for a group of individuals of 7% one needs to aim for 6% for each individual as not all persons will achieve the stated goal. In fact, the operational goal in the DCCT intensive group was an A1c of < 6.05% while the overall achieved A1c was 7.2%. On the other hand, A1c targets appropriately may be set higher in patients with type 1 diabetes and hypoglycemia unawareness, those with limited life expectancies, in very young children, or those with co-morbid conditions that could be aggravated by hypoglycemia (e.g known cerebrovascular disease and a history of transient ischemic attacks).

SMBG is an important tool to reach this target. Currently, the ADA suggests 3 or more home glucose tests each day for patients receiving insulin. However, many patients with type 1 diabetes will require more testing to reach these targets safely, without significant hypoglycemia. Indeed, the ADA also suggests more frequent testing to achieve the postprandial target which is < 180 mg/dL 1 to 2 hours after eating.

It should also be pointed out that specific non-glycemic targets have also been recommended (Table 1). For blood pressure, all patients with diabetes should maintain blood pressures at least below 130/80, and even lower targets should be considered if albuminuria is present. Second, the primary goal for LDL-cholesterol is below 100 mg/dL, and for those over 40 years old statin therapy to achieve an LDL-cholesterol reduction of 30-40% regardless of baseline LDL is recommended. For those with known cardiovascular disease, it is suggested an LDL-cholesterol reduction with a statin to achieve an LDL reduction of 30-40% for all patients but with a primary LDL target of 70 mg/dL.