Diabetes (A1C Targets) — SCE Endocrinology MCQ

Correct answer: C — <7% for most nonpregnant adults

The correct answer is C, <7% for most nonpregnant adults, because current diabetes guidance sets an individualised, risk-stratified HbA1c target rather than a single fixed number for every patient. NICE guidance for type 2 diabetes recommends 48 mmol/mol (6.5%) for people managed by lifestyle measures or a single non-hypoglycaemia-inducing drug, stepping up to 53 mmol/mol (approximately 7.0%) once a drug associated with hypoglycaemia, such as a sulphonylurea or insulin, is added. This patient has no major comorbidities and no hypoglycaemia risk, so a target in the region of 7% (53 mmol/mol) or tighter is appropriate and achievable without undue risk, reflecting the principle that targets are individualised according to treatment, comorbidity, and hypoglycaemia risk rather than fixed at one universal figure. This stratified approach balances microvascular risk reduction against the harms of over-treatment. Why the other options are wrong: E. <6.0% for all: this is tighter than any guideline recommends as a default; targets this low are reserved for select low-risk individuals and pursuing them universally increases hypoglycaemia and mortality risk seen in intensive-control trials. B. <6.5% mandatory: this ignores individualisation; NICE reserves 48 mmol/mol (6.5%) for those on lifestyle or non-hypoglycaemic monotherapy, not as a compulsory target once hypoglycaemia-risk drugs are used. D. <8.5% universal: this is far too lenient as a default target and is only appropriate for frail patients, those with limited life expectancy, or significant comorbidity/hypoglycaemia risk, none of which apply here. A. No A1C target is recommended: guidelines explicitly recommend setting and reviewing individualised HbA1c targets, so omitting a target altogether is incorrect and would remove a key marker for treatment escalation. Key point: HbA1c targets in type 2 diabetes are individualised, typically 48 mmol/mol (6.5%) on lifestyle or metformin alone, rising to around 53 mmol/mol (7.0%) once hypoglycaemia-risk drugs are used, rather than one fixed percentage for all patients.

Reference: NICE Guideline NG28, Type 2 diabetes in adults: management, HbA1c target values, www.nice.org.uk/guidance/ng28