While an HbA1c target of less than 7% to reduce microvascular disease is a generally accepted level, the evidence for an HbA1c target in relation to macrovascular risk is less compelling
Consensus indicates that an HbA1c of less than 7% should be targeted but with acknowledgement of need to pay attention to the individual requirement of the patient.
Fasting plasma glucose should be less than 120mg % (7.2mmol/l) and postprandial less than 160-180mg % (9-10mmol/l) on an individualized basis.
Ideally tight glycemic control should be started early in the course of the disease in younger people and without attendant comorbidities.
Stringent targets like HbAlc 6-6.5% may be considered in selected patients with short disease duration, long life expectancy & no CVD, if it can be achieved without hypoglycaemia or other adverse effect.
For critically ill indoor patients insulin therapy is indicated at a threshold of no greater than 180mg %( l0mmol/l) (ADA2008)
Once insulin therapy has been started in critically ill patients a glucose range of 140-180 mg% is recommended.
With the preferred method of intravenous insulin infusion, frequent glucose monitoring is essential to minimize occurrence of hypoglycaemia and to achieve optimal glucose control.
Tight glucose control (80 – 110 mg %) has not been associated with mortality benefit in many trials. In past some trials show increase mortality.
Table 2: Current Glycemic Targets (ESC/EASD guidelines) [1].