Know Your Targets
The A1c level at or above which a patient is flagged as “poor control” on the HEDIS glycemic measure.
What is greater than 9%?
HEDIS poor-control indicator is >9%; every A1c >10 patient is in this bucket.
This first-line oral agent is contraindicated when eGFR falls below 30.
What is metformin?
Dose-reduce below 45; stop below 30.
Patient's A1c is 11.5% with polyuria, polydipsia, and weight loss; this therapy should start now.
What is (basal) insulin?
Symptomatic hyperglycemia warrants prompt insulin.
Among Medicare beneficiaries with diabetes, hospitalizations from this outnumber those from hyperglycemia.
What is hypoglycemia?
Drives the case for individualized, safety-first targets.
The general A1c target range for a healthy older adult with few comorbidities and intact function.
What is <7.0 to 7.5%?
Individualized targets; healthiest older adults benefit from tighter control.
Preferred drug class for a patient with established heart failure, to cut HF hospitalization and CV death.
What are SGLT2 inhibitors?
Cardiorenal benefit independent of glucose lowering.
Before adding another drug to a patient with A1c >10, always assess this common, modifiable root cause.
What is medication nonadherence (including cost and access)?
Adding drugs to an adherence problem fails.
This cheap insulin-secretagogue class carries high hypoglycemia risk and should be avoided in older adults (especially glyburide).
What are sulfonylureas?
If used, prefer glipizide/glimepiride over glyburide.
For a very complex patient with limited life expectancy, the goal is to avoid these two extremes instead of hitting a strict number
What are hyperglycemia and hypoglycemia?
Function- and safety-based goal when intensive control won't help.
For a patient with ASCVD, this injectable class reduces major cardiovascular events independent of A1c.
What are GLP-1 receptor agonists?
MACE reduction is a class effect for several agents.
When adding a GLP-1 RA or SGLT2i to a patient already on insulin, do this to the insulin dose.
What is reduce it (deintensify)?
Prevents hypoglycemia as the new agent takes effect.
Pioglitazone should be avoided in patients with this condition (NYHA class III/IV).
What is heart failure?
TZDs cause fluid retention.