Get Permission
Rev Diabet Stud, 2009, 6(1):6-12 DOI 10.1900/RDS.2009.6.6

The Individualized Target HbA1c: A New Method for Improving Macrovascular Risk and Glycemia Without Hypoglycemia and Weight Gain

Roy Eldor, Itamar Raz

Diabetes Research Center, Department of Medicine, Hadassah-Hebrew University Hospital, Jerusalem 91120, Israel
Address correspondence to: Roy Eldor, e-mail: eldorroy@yahoo.com

Manuscript submitted April 21, 2009; resubmitted May 17, 2009; accepted May 19, 2009.

Keywords: diabetes, cardiovascular disease, obesity, weight gain, glycemic control, ACCORD, UKPDS


Both the DCCT and UKPDS trials demonstrated that improved glycemic control reduces microvascular complications. Inconclusive evidence, however, has remained on the question of the effect of glycemic control on macrovascular disease (with special emphasis on cardiovascular morbidity and mortality). In the last year, the data from four large trials were published, directly addressing this question (ACCORD, ADVANCE, VADT and UKPDS-80), yet the results were conflicting. Close inspection of the structure of three of these trials (ACCORD, ADVANCE and VADT) revealed inadequacies that may explain the unfavorable results, such as the inclusion of mainly elderly patients with previous macrovascular complications. It is not surprising that intensive glycemic control resulted in a rise of hypoglycemic events yet did not decrease macrovascular morbidity or mortality in these cohorts. On the other hand, the UKPDS-80 trial, a follow-up of the original UKPDS, showed that intensive glycemic control was beneficial when initiated in newly diagnosed patients. These results led us to develop a new individualized method of determining the target HbA1c based on the characteristics of the individual. This method considers the patient’s possible benefit from glycemic control, the risk of suffering hypoglycemic events and consequences suffered from the hypoglycemic event. It is essential that the target HbA1c be tailored to the patient, with different goals set for the recently diagnosed “healthy” and young patient on the one hand, and the elderly patient with co-morbidities and polypharmacy on the other hand. We further suggest a method of comparing and choosing between the different hypoglycemic drugs available. Drugs should be considered not only based on their hypoglycemic effect but also on several other attributes such as effects on weight, glycemic durability, cardiovascular protection, individual experience with the drug, method of delivery and side effect profiles. Scoring the different attributes allows us to compare between different preparations and choose the most suitable drugs for each individual patient. Using our newly suggested system, a physician will first calculate the adequate HbA1c goal for his patient and then choose the drug that will best suit him, thus tailoring the treatment to the patients needs.

Fulltext: HTML , PDF (293KB)

This article has been cited by other articles:

Personalizing treatment in type 2 diabetes: a self-monitoring of blood glucose inclusive innovative approach

Ceriello A, Gallo M, Armentano V, Perriello G, Gentile S, De Micheli A

Diabetes Technol Ther 2012. In press

Role of incretin therapy at various stages of diabetes

Cernea S

Rev Diabet Stud 2011. 8(3):323-338

Intensive glycemic control and cardiovascular disease: Are there patients who may benefit?

Chokrungvaranon N, Deer J, Reaven PD

Postgrad Med 2011. 123(6):114-123

The economic and clinical benefits of adequate insulin initiation and intensification in people with type 2 diabetes mellitus

Asche CV, Bode B, Busk AK, Nair S

Diabetes Obes Metab 2011. In press

Novel incretin-based agents and practical regimens to meet needs and treatment goals of patients with type 2 diabetes mellitus

Garber AJ

J Am Osteopath Assoc 2011. 111(7 Suppl 5):S20-S30

Intervention at the very early stage of type 2 diabetes

Aizawa T, Funase Y

Diabetologia 2011. 54(3):703-704

Diabetes and cardiovascular disease

Bloomgarden ZT

Diabetes Care 2011. 34(3):e24-30

Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service, a new medical information system

Lim S, Kang SM, Shin H, Lee HJ, Won Yoon J, Yu SH, Kim SY, Yoo SY, Jung HS Park KS, Ryu JO, Jang HC

Diabetes Care 2011. 34(2):308-333

Management of type 2 diabetes: more evidence is required to address the clinical and contextual facets

Hernandez-Jimenez S, Aguilar-Salinas CA, Mehta R, Rull JA, Gomez-Perez FJ

Curr Diabetes Rev 2011. 7(2):99-105

Resistance exercise training lowers HbA1c more than aerobic training in adults with type 2 diabetes

Bweir S, Al-Jarrah M, Almalty AM, Maayah M, Smirnova IV, Novikova L, Stehno-Bittel L

Diabetol Metab Syndr 2009. 1(1):27