Glycemic Control and Diabetic Complications—Is the Predominant Current Rationale Rational?

Although the level of glycated hemoglobin (HbA 1C ) reflects chronic glycemic control, treatment-induced decreases in HbA 1C in patients who have established diabetes do not always predict beneficial clinical outcomes. Clinical outcomes are dramatically influenced by the history of previous glycemic control, the extent of current clinical complications, and the side effects of therapeutic agents. Rational approaches to the intensity of glycemic control in individual patients should take these factors into consideration, as well as in setting an appropriate goal for the HbA 1C target.