You initiated first line therapy for a Type II diabetic patient with no other serious illness and at low risk for hypoglycemia whose Hemoglobin A1C is 8.1%. In three to four months, you plan to bring the patient in to test his hemoglobin A1C (HbA1C), what would a reasonable goal HbA1C be?

Rationale: A. A goal of greater than 7.5% would be inappropriate for a relatively healthy patient with a low risk of hypoglycemia. Such a target allows for chronic hyperglycemia, which increases the long-term risk of microvascular complications such as retinopathy and nephropathy. Clinical guidelines suggest more stringent targets for patients who can safely achieve them without significant adverse effects. B. For most non-pregnant adults with Type 2 diabetes and no significant comorbidities, a target HbA1C of less than 7% is recommended by the American Diabetes Association. This goal balances effective glycemic control with patient safety and has been shown to reduce the incidence of long-term diabetic complications. It is appropriate for a patient newly initiated on first-line therapy. C. A target of less than 9% is far too high for a patient whose baseline is 8.1% and who is starting treatment. This goal would represent a failure of therapy and would leave the patient at high risk for the progression of metabolic disease. Stricter control is necessary to prevent the glucose-mediated damage associated with poorly managed diabetes mellitus. D. While a level below 5.5% is within the normal non-diabetic range, it is often difficult and potentially dangerous to achieve in a diabetic patient on medication. Targeting such a low value significantly increases the risk of symptomatic and severe hypoglycemia. For most diabetic individuals, the risk of hypoglycemia at these levels outweighs the benefits of near-normal glycemic status.