The American College of Physicians developed this guidance statement to guide clinicians in selecting targets for pharmacologic treatment of type 2 diabetes.

The National Guideline Clearinghouse and the Guidelines International Network library were searched (May 2017) for national guidelines, published in English, that addressed hemoglobin A_1c (HbA_1c) targets for treating type 2 diabetes in nonpregnant outpatient adults. The authors identified guidelines from the National Institute for Health and Care Excellence and the Institute for Clinical Systems Improvement. In addition, 4 commonly used guidelines were reviewed, from the American Association of Clinical Endocrinologists and American College of Endocrinology, the American Diabetes Association, the Scottish Intercollegiate Guidelines Network, and the U.S. Department of Veterans Affairs and Department of Defense. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the guidelines.

Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care.

Clinicians should aim to achieve an HbA_1c level between 7% and 8% in most patients with type 2 diabetes.

Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA_1c levels less than 6.5%.

Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA_1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population.

美国内科医学院制定了此指导性声明，以指导临床医生选择2型糖尿病的药物治疗靶标。

（2017年5月）在国家指南信息交换所和指南国际网络库中搜索了以英语发布的，针对血红蛋白A _1c（HbA _1c）的国家指南）非孕妇门诊成人2型糖尿病的治疗目标。作者确定了美国国立卫生与医疗保健研究院和临床系统改进研究所的指南。此外，还审查了美国临床内分泌学家协会和美国内分泌学会，美国糖尿病协会，苏格兰大学间指南网络以及美国退伍军人事务部和国防部的4种常用指南。AGREE II（研究和评估指南的评估II）工具用于评估指南。

临床医生应在讨论药物治疗的利弊，患者的偏爱，患者的总体健康和预期寿命，治疗负担以及护理费用的基础上，个性化2型糖尿病患者的血糖控制目标。

临床医生的目标应该是使大多数2型糖尿病患者的HbA _1c水平达到7％至8％。

对于HbA _1c水平低于6.5％的2型糖尿病患者，临床医生应考虑加强药物治疗。

临床医生应治疗2型糖尿病患者，以最大程度地减少与高血糖症有关的症状，并避免针对因高龄（80岁或以上），居住在疗养院或慢性病中而导致预期寿命少于10年的患者达到HbA _1c水平疾病（例如痴呆，癌症，终末期肾脏疾病或严重的慢性阻塞性肺疾病或充血性心力衰竭），因为危害超过了该人群的收益。