Determining the optimal fasting glucose target for patients with type 2 diabetes: results of the multicentre, open-label, randomized-controlled FPG GOAL trial
Open accessAbstract
The optimal fasting blood glucose (FBG) target of achieving HbA1c less than 7.0% in type 2 diabetes (T2D) patients remains controversial. This open-label trial randomized (1:3:3) 947 adults with uncontrolled T2D (HbA1c >7% to ≤10.5%) who were using one to three oral antidiabetic drugs to achieve an FBG target of 3.9 < FBG ≤5.6 mmol/L (Group 1), 3.9 < FBG ≤6.1 mmol/L (Group 2) or of 3.9 < FBG ≤7.0 mmol/L (Group 3). Targets were achieved using a pre-defined insulin glargine 100 U/mL titration scheme. The primary endpoint was proportion of patients achieving HbA1c <7.0% at 24 weeks. At 24 weeks, 44.4%, 46.1% and 37.7% of patients achieved HbA1c <7.0% in Groups 1, 2 and 3, respectively (P = 0.017; Group 2 vs Group 3). Alert hypoglycaemia (glucose ≤3.9 mmol/L) was significantly more frequent in Group 1 than in Group 3 (38.9 vs 23.3%; P < 0.001) but was not in Group 2 vs Group 3 (27.5% vs 23.3%; P = 0.177). Clinically important hypoglycaemia (glucose ≤3.0 mmol/L) was reported in 4.8%, 2.0% and 3.8% of patients in Groups 1, 2 and 3, respectively. In conclusion, the optimal FBG target for most Chinese patients with T2D appears to be 3.9-6.1 mmol/L.
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Some individuals with type 1 diabetes or type 2 diabetes and hypoglycemia who have a fear of hyperglycemia are resistant to relaxation of glycemic targets.
“Conversely, some individuals with type 1 diabetes or type 2 diabetes and hypoglycemia who have a fear of hyperglycemia are resistant to relaxation of glycemic targets (74)(75)(76)(77)(78)(79)(80)(81)(82)(83).”
From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [83]
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International Diabetes Federation 2017
Carracher, A. M., Marathe, P. H., & Close, K. L. (2018) · Journal of Diabetes · doi:10.1111/1753-0407.12644 · Cited by 13,369 · see citing works
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6. Glycemic Targets: Standards of Medical Care in Diabetes—2018
American Diabetes Association (2017) · Diabetes Care · doi:10.2337/dc18-s006 · Cited by 764 · see citing works
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Standards of care for type 2 diabetes in China
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6. Glycemic Targets: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s006 · Cited by 1,403 · see citing works
6. Glycemic Targets: <i>Standards of Medical Care in Diabetes—2021</i>
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s006 · Cited by 847 · see citing works
6. Glycemic Targets: <i>Standards of Medical Care in Diabetes—2020</i>
American Diabetes Association (2020) · Diabetes Care · doi:10.2337/dc20-s006 · Cited by 744 · see citing works
6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i>
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s006 · Cited by 684 · see citing works
- Authors
- Yang, W., Ma, J., Yuan, G., Li, L., Zhang, M., Lu, Y., Ye, X., Song, W., Liu, M., Wu, J., Chen, R., Li, Y., Zhang, X., Cui, N., & Yang, J.
- Affiliations
- China-Japan Friendship Hospital (CN)
- Nanjing First Hospital (CN)
- Affiliated Hospital of Jiangsu University (CN)
- Sheng Jing Hospital (CN)
- Fudan University (CN)
- Second Affiliated Hospital of Nanjing Medical University (CN)
- Changzhou No.2 People's Hospital (CN)
- Chenzhou First People's Hospital (CN)
- Tianjin Medical University General Hospital (CN)
- Wuhan Third Hospital (CN)
- Lishui City People's Hospital (CN)
- Sanofi (China) (CN)
- Beijing Tongren Hospital (CN)
- Corresponding author
- Yang, Wenying
- ORCID
- Venue
- Diabetes Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2019-06-10
- Volume
- 21
- Issue
- 8
- Pages
- 1973-1977
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- PMC
- PMC6772047
- OpenAlex
- W2934647493
- Cited by
- 17
- References
- 7
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 2
- FWCI
- 2.03
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-09-10)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Obesity and Metabolism (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, HbA1c, insulin glargine, hypoglycemia, glycemic control, oral antidiabetic drugs, Chinese patients
- MeSH terms
- Insulin Glargine, Adult, Blood Glucose, Diabetes Mellitus, Type 2, Fasting, Female, Goals, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Male, Middle Aged, Reference Values, Treatment Outcome
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