Insulin Analogs or Premixed Insulin Analogs in Combination With Oral Agents for Treatment of Type 2 Diabetes

Philip Levy, MD, FACE

Disclosures

April 16, 2007

Glycemic Targets

Currently accepted treatment targets for A1C levels, according to the American Diabetes Association (ADA), are less than 7.0% or as close to normal as possible without causing undue hypoglycemia.[12] The American Association of Clinical Endocrinologists (AACE) recommends a target of 6.5% or less.[13] However, in a study reporting glycemic control rates among US adults with type 2 diabetes from 1999 to 2000,[14] less than 36% of patients reached a goal of less than 7%.

The ADA and AACE recommendations also differ slightly for optimal control fasting plasma glucose (FPG) and postprandial glucose (PPG) ( Table 1 ). Although both are strongly correlated with A1C,[15] PPG may more accurately predict overall glycemic control and correlate better with A1C than FPG.[16] The relative contribution of PPG to A1C increases as glycemic control improves while the relative contribution of FPG increases gradually with rising A1C.[17]

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