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Revisiting Glycemic Control Targets: Survival Outcomes by Glycated Hemoglobin Levels Among Patients With Diabetes

Donna Shu-Han Lin1, Hao-Yun Lo1, Jen-Kuang Lee2,3,4,5,6

  • 1Division of Cardiology, Department of Internal Medicine Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.

Journal of the American Heart Association
|May 6, 2026
PubMed
Abstract

Insights

Optimal glycemic targets for type 2 diabetes vary by outcome and sex. Individualized management is key to balancing benefits and risks for patients on modern treatments.

Area of Science:

  • Endocrinology
  • Cardiology
  • Nephrology

Background:

  • Glycemic targets for type 2 diabetes are debated, especially with evolving treatments.
  • Contemporary glucose-lowering therapies necessitate reevaluation of optimal HbA1c levels.

Purpose of the Study:

  • To reevaluate optimal glycemic targets in type 2 diabetes patients using modern antidiabetic therapies.
  • To assess the impact of long-term mean HbA1c on cardiovascular, renal, and heart failure outcomes.

Main Methods:

  • Retrospective cohort study of 16,604 type 2 diabetes patients initiating DPP-4 inhibitors.
  • Categorization by long-term mean HbA1c quintiles with follow-up through 2021.
  • Analysis using Cox models and restricted cubic splines for outcomes including MACE, renal events, and HF hospitalization.

Main Results:

  • Higher HbA1c quintiles (4th and 5th) correlated with increased major adverse cardiovascular events (MACE).
  • J-shaped relationships observed for MACE and renal outcomes, with lowest risk near HbA1c of 7%.
  • Heart failure risk increased linearly with HbA1c; sex differences noted in cardiovascular risk patterns.

Conclusions:

  • Optimal glycemic targets are outcome- and sex-dependent in patients on contemporary therapies.
  • Individualized HbA1c management is crucial for balancing cardiovascular and renal benefits against risks.
  • Sex-specific approaches may be necessary for optimizing diabetes care.
Keywords:
cardiorenal outcomesglycated hemoglobinheart failuresex differences

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