Treatment Goals and Glycemic Targets

A1C: The Anchor Metric, Individualized

For many nonpregnant adults with diabetes, the general glycemic goal is A1C <7% (<53 mmol/mol). This target is not universal — the ADA calls for individualization around it:

• More stringent (for example, <6.5%) may be appropriate if achievable safely, without significant hypoglycemia or added treatment burden — typically for people with a shorter disease duration, long life expectancy, and no significant cardiovascular disease
• Less stringent (for example, <8%) is appropriate for people with limited life expectancy, extensive comorbidities, a history of severe hypoglycemia, or long-standing diabetes in whom the general goal is difficult to achieve despite optimized, appropriately intensified therapy

This individualization principle — matching the target to the person, not applying one number universally — is the single most testable concept in this section and underlies every other goal below. These same principles extend into specific populations covered later in this guide: pregnancy uses distinct, tighter glycemic targets (Chapter 12.3), and children and older adults each warrant their own age-adjusted approach (Chapter 12.2) — the general <7% target here is the starting point for typical nonpregnant adults, not a universal number applied without modification.

CGM-Based Metrics: TIR, TBR, TAR, and GMI

Continuous glucose monitoring (CGM) has added standardized metrics that give a fuller day-to-day picture than A1C alone:

A TIR goal of more than 70% correlates with an A1C of roughly 7%. Older or high-risk adults, and those with limited life expectancy, use a relaxed TIR goal of at least 50% (at least 12 hours per day) paired with tighter hypoglycemia protection — a TBR <70 mg/dL target of less than 1%, or under 15 minutes per day.

The Glucose Management Indicator (GMI) estimates the A1C that a person's mean CGM glucose would predict, calculated as:

GMI (%) = 3.31 + 0.02392 x mean glucose (mg/dL)

GMI requires at least 14 days of CGM data, ideally captured on at least 70% of those days for reliability. GMI can diverge from a lab-drawn A1C; that divergence is itself clinically informative and should prompt review of red-cell factors (such as anemia or hemoglobinopathy) or CGM data quality, rather than being dismissed as simple error. Coefficient of variation (%CV), calculated as the standard deviation of glucose divided by the mean glucose, measures intraday glycemic variability; a %CV of 36% or lower is the general stability target most people with diabetes should aim for. An emerging, stricter metric, Time in Tight Range (70-140 mg/dL), is gaining attention for populations such as automated insulin delivery users and pregnancy, though it is not yet a universal ADA target the way TIR is.

Blood Pressure Goals

If it can be safely attained, the on-treatment blood pressure goal for people with diabetes and hypertension is less than 130/80 mmHg. A more intensive systolic goal of less than 120 mmHg should be encouraged, if tolerated, for individuals at high cardiovascular or kidney risk. As with glycemic targets, blood pressure targets are individualized based on tolerability, overall risk, and shared decision-making with the person.

Lipid Goals

Statin intensity and LDL cholesterol targets scale with ASCVD risk:

If the LDL goal is not met on maximally tolerated statin therapy, ezetimibe or a PCSK9 inhibitor may be added; bempedoic acid is an option for people who are statin-intolerant.

Beyond the Numbers: Risk Reduction and Quality of Life

Glycemic, blood-pressure, and lipid targets exist to reduce the microvascular and macrovascular complications covered in Chapters 10 and 11 — but the ADA explicitly frames treatment goals as person-centered, not purely numeric. Reducing overall ASCVD risk also means addressing weight management, smoking cessation, and, where appropriate, cardioprotective and renal-protective medication classes such as SGLT2 inhibitors and GLP-1 receptor agonists, covered in Chapter 8. Equally, every target must be weighed against quality of life: treatment burden, hypoglycemia risk, and the person's own stated priorities. Shared decision-making tools, including decision aids that lay out absolute risk reduction in plain-language terms, help ensure a person's own priorities, rather than a guideline number alone, drive which targets are pursued and how aggressively. A CDCES translates population-level targets like these into an individualized plan negotiated with, not imposed on, the person with diabetes, revisiting the plan whenever life circumstances or goals change.