HbA1c: Is it the Most Important Therapeutic Target in outPatient Management of Diabetes?

HbA1c is currently the best clinical measure of assessing the degree of glycemic exposure for patients with diabetes. Epidemiologic, observational, and clinical trials have found a consistent relationship between HbA1c, improved glycemic control, and the microvascular risks of diabetes, while there remains an uncertainty about the risk-benefits of aggressive glycemic control and macrovascular events. HbA1c as a measure of glycemic control is an important but not the only therapeutic target in the outpatient management of diabetes. Diabetes management requires the collective attention to other proximate outcomes; biomarkers (e.g., lipids, blood pressure, and weight) and behavioral measures (e.g., knowledge, adherence, trust) that predict patient important outcomes of morbidity, mortality, and quality of life.