About 30.3 million Americans (9.4%) have diabetes mellitus (DM). 1 Veterans are disproportionately affected—about 1 in 4 of those who receive US Department of Veterans Affairs (VA) care have DM. 2 The consequences of uncontrolled DM include microvascular complications (eg, retinopathy, neuropathy, and nephropathy) and macrovascular complications (eg, cardiovascular disease).
The American Diabetes Association (ADA) recommends achieving a goal hemoglobin A 1c (HbA 1c) level of < 7% to prevent these complications. However, a goal of < 8% HbA 1c may be more appropriate for certain patients when a more strict goal may be impractical or have the potential to cause harm. 3 Furthermore, guidelines developed by the VA and the US Department of Defense suggest a target HbA 1c range of 7.0% to 8.5% for patients with established microvascular or macrovascular disease, comorbid conditions, or a life expectancy of 5 to 10 years. 4