How to individualize glycemic targets in adults?

Abstract

Glycemic levels have been the cornerstone of diabetes mellitus (DM) treatment for many years. They serve as a way to assess the risk of progression, primarily to chronic micro- and macrovascular complications, as well as the risk of developing acute complications. Historically, glycemic control has been measured using glycated hemoglobin (HbA1c), a rigid value with limitations due to its inability to reflect glycemic variability or to account for individual factors that could confound the interpretation of results (anemia, hemoglobinopathies, chronic kidney disease, pregnancy, erythropoietin use, etc.).

The advent of continuous glucose monitors has led to a system that better assesses glycemic variability and minimizes the influence of individual factors that can alter HbA1c results.

However, even if both methods were perfect, we cannot forget that the objective differs for each individual, considering the person as a whole, with their associated pathologies, life expectancy, access to medication, ability to understand and comply with "glycemic-ideal" guidelines, and the risk of complications that could arise, for example, from hypoglycemia.

The ADA/EASD/IDF/NICE guidelines, among others, offer a perspective that helps us understand that therapeutic goals are individualized. These guidelines and their recommendations are just that: suggestions that do not replace common sense, clinical judgment, and the realistic possibilities of achieving the ideal for each patient. It is an individual decision that will be made in each consultation.