Diabetes targets — SCE Endocrinology MCQ

Correct answer: D — <7.0% for many nonpregnant adults

The correct answer is D, <7.0% for many nonpregnant adults. This is the widely accepted default HbA1c goal quoted in major diabetes guidance for the general adult population with type 2 diabetes, reflecting a balance between reducing microvascular and macrovascular complications and avoiding excessive treatment burden or hypoglycaemia. UK guidance mirrors this concept: NICE recommends an HbA1c aim of 53 mmol/mol (7.0%) for adults on a medicine associated with hypoglycaemia, with a tighter 48 mmol/mol (6.5%) reserved for those on lifestyle measures or a single non-hypoglycaemia-inducing drug. Because the stem describes a general goal rather than a rigid universal figure, and targets are individualised according to comorbidity burden and hypoglycaemia risk, <7.0% represents the standard, broadly applicable benchmark taught for most nonpregnant adults with type 2 diabetes. Why the other options are wrong: A. <6.0% for all adults: this is overly tight for a blanket target; pursuing such intensive control in unselected patients increases hypoglycaemia risk without proportionate benefit and is not endorsed as a universal goal. E. <6.5% mandatory: while 6.5% (48 mmol/mol) is used as a target for lower-risk patients on non-hypoglycaemic therapy, it is not a mandatory figure applied to every patient regardless of context; targets are individualised, not fixed. C. <7.5% only if on insulin: this incorrectly implies insulin use automatically permits a looser target as a fixed rule; actual target-setting depends on hypoglycaemia risk, comorbidities and life expectancy, not simply the drug class. B. No specific goal is recommended: guidelines explicitly do set numerical HbA1c targets to guide management, so stating no goal exists is factually incorrect. Key point: <7.0% HbA1c is the general, individualisable target for most nonpregnant adults with type 2 diabetes, with tighter or looser goals reserved for specific risk profiles rather than applied universally.

Reference: NICE Guideline NG28: Type 2 diabetes in adults: management, section 1.5 (HbA1c targets), updated 2022, https://www.nice.org.uk/guidance/ng28