While A1C and blood glucose targets are needed, the ADA emphasizes that glycemic targets should be individualized with the goal of achieving the best possible control while minimizing the risk of severe hyperglycemia and hypoglycemia (Table 7). Goals should be individualized based on duration of diabetes, age/life expectancy, comorbid conditions, known CVD or advanced microvascular complications, hypoglycemia unawareness, and individual patient considerations. More or less stringent glycemic goals may be appropriate for individual patients. Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals.
I think trying to have the lowest possible or “normal” a1c is majoring in the minors and can be very dangerous for the 70% of type 1 diabetics who have their hba1c >=7. There are no studies proving an a1c<7 creates significantly less complications, which is why the general goal is individualized and focuses more on the 70% who are way over 7…I know when I’m snowboarding, swimming, diving, walking the dogs, etc. If I start at 120 mg/DL I’ll have to eat something or I’ll be at 68 or lower when I’m done…and eventually, by going that low every day you will have a lower a1c and hypoglycemic unawareness… its just not worth dying for a lower than 7 hba1c… you might not agree with the accord study, but that’s not the point. If you start your 10 mile bike ride at 97 mg/DL you’ll most likely end in the 50s…you might be fine at 50mg/DL but many others are waking up with the EMTs and an iv of glucose…just hypoglycemic common sense