Current Targets for Lipids, Cholesterol, Blood Pressure, Time in Range, and A1C
By Hope Warshaw
Each year, the American Diabetes Association updates its Standards of Care, or recommended diabetes practice guidelines. The document includes recommendations for target lipid levels, blood pressure and glucose, including Time in Range, A1C, etc. Here are the targets for each of these measures. Discuss your targets with your healthcare providers, they may vary based on a number of factors.
According to the CDC, in 2017-2018 just over 25% of U.S. adults with diagnosed diabetes met target diabetes management goals for glucose, blood pressure, and cholesterol (based on the less stringent A1C goal of <8% vs. <7%), and were non-smokers. Smoking is a risk factor for heart and blood vessel diseases and heart failure. Achieving target levels for glucose, lipids and blood pressure is now viewed as being critical to the prevention and/or delay of diabetes complications.
Assessment frequency: If glucose goals are being met, assess A1C, Time in Range (TIR), or Glucose Management Indicator (GMI) targets at least twice/year. If glucose targets are not being met or treatment has changed to improve glucose management, assess quarterly and as needed.
The A1C target for nonpregnant adults without significant hypoglycemia is at or below 7%. A less stringent goal of less than 8% can be used for people with a history of severe hypoglycemia, limited life expectancy, or advanced diabetes-related complications.
Assessment frequency: If these targets are being met, check A1C at least twice a year. If these targets are not being met or treatment has changed, check every three months and as needed.
Time in Range (TIR) goals
The Time in Range target, or percent of time spent within a healthy glucose range, is at least 70%, with glucose measurements recorded by a continuous glucose monitor (CGM). Additionally, Time below Range (TBR) should be kept to less than 4%. Thresholds for TIR, TBR, and Time Above Range (TAR) are as follows:
Time in Range (TIR): 70 – 180 mg/dL
Time above Range (TAR) (level 1): 181 – 250 mg/dL
Time above Range (TAR) (level 2): greater than 250 mg/dL
Time below Range (TBR) (level 1): 54 – 69 mg/dL
Time below Range (TBR) (level 2): less than 54 mg/dL
Glucose Management Indicator (GMI) vs. A1C
GMI tells you what your approximate A1C is likely to be, based on average glucose levels from CGM readings for 14+ days without an A1C check. Your A1C and GMI level may not match precisely, so discuss the difference with your diabetes care providers.
Glucose goals before and after meals (in nonpregnant adults*)
The following target ranges provide goals for managing your glucose levels surrounding meals.
Fasting and before food/meals: 80-130 mg/dL
Peak after eating (~1-2 hours after start of eating): <180 mg/dL
For all of the above metrics, different targets exist for children, pregnant women and certain other individuals. Discuss individual goals with your healthcare providers to create a goal that best suits you.
Lipid Targets (cholesterol and triglycerides or blood fats)
Managing lipid levels today focuses on minimizing overall risk as opposed to treating based on specific targets. Measurement of total cholesterol is no longer necessary; however, measuring each type (LDL and HDL) is.
Assessment frequency: Obtain a lipid profile which includes the three measures below at diagnosis, the initial medical evaluation, and at least every 5 years thereafter if under 40 years of age. Each measure includes the general recommended target.
Low-density lipoprotein cholesterol (LDL): (Also called bad cholesterol) Less than 100 mg/dL without diabetes, less than 70 mg/dL with diabetes due to the higher incidence of heart and blood vessel diseases and likelihood of having abnormal lipids
High-density lipoprotein cholesterol (HDL): (Also called good or healthy cholesterol) At least 40 mg/dL men, 50 mg/dL women
Triglycerides: Less than 150 mg/dL
People with type 2 diabetes are at an increased risk of having abnormal lipid levels, which contribute to their higher risk of heart and blood vessel diseases. Research has repeatedly shown that the use of a statin medication, such as Lipitor or Atorvastatin, to lower LDL-cholesterol can reduce these risks. Once someone starts taking a statin medication, LDL-cholesterol should be assessed 4-12 weeks after starting this medication or after any change in dose, and on an individual basis. Learn more about how to maintain the health of your heart and blood vessels.
Blood Pressure Targets
Non-pregnant adults who have diabetes and high blood pressure and HIGH risk for heart and blood vessel diseases should generally target a blood pressure less than 130/80 mmHg (if it can be safely attained). However, blood pressure targets should be individualized based on risk, adverse effects of blood pressure medication and personal preferences.
Non-pregnant adults with diabetes and high blood pressure at LOWER risk for heart and blood vessel diseases should target a blood pressure less than 140/90 mmHg. If blood pressure is over 140/90 mmHg, people should, in addition to actions detailed below, start blood pressure medication and work to achieve this target. Blood pressure targets should be individualized based on risk, adverse effects of blood pressure medication and personal preferences.
Assessment frequency: Blood pressure should be measured at every routine clinical visit. Every person with high blood pressure and diabetes should also monitor their blood pressure at home. Learn more about how to maintain the health of your heart and blood vessels and the health of your kidneys.