The DOI matches its Crossref record; 136 of the 136 references it cites were found in a registry or an index; none of the 133 sources its claims cite is checked for support yet.
6. Glycemic Targets: Standards of Care in Diabetes—2023
Open accessAbstract
The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This ADA *Standards of Care in Diabetes—2023* section provides evidence-based recommendations for assessing glycemic control and setting individualized glycemic targets in diabetes. It emphasizes A1C, CGM-derived time in range/GMI, hypoglycemia prevention, and balancing benefits against risks.
Key findings
- For many nonpregnant adults, the A1C goal is <7% (53 mmol/mol) without significant hypoglycemia; a parallel CGM goal is time in range >70%, time below range <4%, and time <54 mg/dL <1%. Less stringent A1C goals such as <8% (64 mmol/mol) may be appropriate for limited life expectancy or when harms outweigh benefits.
- DCCT intensive versus standard glycemic control (mean A1C about 7% vs. about 9%) reduced development and progression of microvascular complications by 50–76%; EDIC follow-up showed a 57% reduction in nonfatal MI, stroke, or cardiovascular death in the intensive arm. ACCORD was halted early for increased mortality in the intensive arm (1.41% vs. 1.14% per year; hazard ratio 1.22 [95% CI 1.01–1.46]).
- The ADAG study in 507 adults (83% non-Hispanic White) found an A1C–average glucose correlation of r = 0.92 based on 2,700 readings per A1C measurement; retrospective data suggest 70% time in range aligns with an A1C of 7%. CGM improved A1C by 0.3–0.6% in people with type 1 or type 2 diabetes above target.
- Hypoglycemia is classified as level 1: glucose <70 mg/dL (3.9 mmol/L) and ≥54 mg/dL (3.0 mmol/L); level 2: <54 mg/dL (3.0 mmol/L); level 3: a severe event requiring assistance. Treatment is approximately 15–20 g glucose, repeated after 15 minutes if BGM shows continued hypoglycemia.
Methods
- Design: ADA clinical practice recommendations, updated annually by the multidisciplinary Professional Practice Committee, with evidence-graded recommendations.
- Data: narrative synthesis of trials and studies including DCCT/EDIC, UKPDS, Kumamoto, ACCORD, ADVANCE, VADT, and ADAG, plus consensus reports; no new primary data collection.
- Analysis: expert consensus and evidence review; detailed evidence-grading methodology is referred to the Introduction and Methodology section.
Limitations
- Stated: A1C is an indirect measure affected by red blood cell turnover, hemoglobin variants, pregnancy, end-stage kidney disease, and other conditions, and it does not measure glycemic variability or hypoglycemia. CGM studies had differing entry A1C and endpoints and must be interpreted carefully; no study reported a decrease in level 3 hypoglycemia, and type 2 diabetes CGM evidence on hypoglycemic events is limited.
- Evident: This is a guideline/standards chapter rather than a primary systematic review; methods and evidence grading are deferred to another section, and the recommendations are intended to be individualized rather than applied rigidly.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
0 of 133 cited sources checked · 0 supported · 0 flagged
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“No study to date has reported a decrease in level 3 hypoglycemia.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Another genetic variant, X-linked glucose-6-phosphate dehydrogenase G202A, carried by 11% of African American individuals, was associated with a decrease in A1C of about 0.8% in hemizygous men and 0.7% in homozygous women compared with those without the trait (20).”
What the sources say
- Not checked yetcites [20] Wheeler, 2017, Impact of common genetic determinants of hemoglobin A1c on type 2 diabetes risk and diagnosis in ancestrally diverse populations: a transethnic genome-wide meta-analysis, PLoS Med source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“the international A1C-Derived Average Glucose (ADAG) study, which assessed the correlation between A1C and frequent BGM and CGM in 507 adults (83% non-Hispanic White) with type 1, type 2, and no diabetes (13)”
What the sources say
- Not checked yetcites [13] Nathan, 2008, Translating the A1C assay into estimated average glucose values, Diabetes Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“In a report, mean glucose measured with CGM versus central laboratory-measured A1C in 387 participants in three randomized trials demonstrated that A1C may underestimate or overestimate mean glucose in individuals (12).”
What the sources say
- Not checked yetcites [12] Beck, 2017, The fallacy of average: how using HbA1C alone to assess glycemic control can be misleading, Diabetes Care source
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Taken together, A1C and glucose parameters are essential for the optimal assessment of glycemic status.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“However, most assays in use in the U.S. are accurate in individuals who are heterozygous for the most common variants (ngsp. org/interf.asp).”
What the sources say
- Not checked yetcites ngsp. org/interf.asp
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Other studies have also demonstrated higher A1C levels in African American participants than in White participants at a given mean glucose concentration (15,16).”
What the sources say
- Not checked yetcites [15] Selvin, 2016, Are there clinical implications of racial differences in HbA1c? A difference, to be a difference, must make a difference, Diabetes Care source
- Not checked yetcites [16] Bergenstal, 2017, Racial differences in the relationship of glucose concentrations and hemoglobin A1c levels, Ann Intern Med source
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Individuals on a variety of insulin treatment plans can benefit from CGM with improved glucose control, decreased hypoglycemia, and enhanced self-efficacy (Section 7, “Diabetes Technology”) (1).”
What the sources say
- Not checked yetcites [1] Deshmukh, 2020, Effect of flash glucose monitoring on glycemic control, hypoglycemia, diabetes-related distress, and resource utilization in the Association of British Clinical Diabetologists (ABCD) nationwide audit, Diabetes Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“In contrast, a recent report in Afro-Caribbean individuals found lower A1C relative to glucose values (17).”
What the sources say
- Not checked yetcites [17] Khosla, 2021, HbA1c performance in african descent populations in the United States with normal glucose tolerance, prediabetes, or diabetes: a scoping review, Prev Chronic Dis source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“For example, conditions that affect red blood cell turnover (hemolytic and other anemias, glucose-6-phosphate dehydrogenase deficiency, recent blood transfusion, use of drugs that stimulate erythropoiesis, endstage kidney disease, and pregnancy) may result in discrepancies between the A1C result and the patient's true mean glycemia (11).”
What the sources say
- Not checked yetcites [11] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2020, KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease, Kidney Int source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- Probably not a substantial claim. 23
- It may state two separate claims as one. 29
- The quote only partly states this claim. 1
None of the sources cited for this claim have been checked yet.
In the paper
“Clinicians should note that the mean plasma glucose numbers in Table 6.1 are based on 2,700 readings per A1C measurement in the ADAG trial.”
What the sources say
Strength:plain· not yet calibratedn = 507Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“A small study comparing A1C to CGM data in children with type 1 diabetes found a highly statistically significant correlation between A1C and mean blood glucose, although the correlation (r = 0.7) was significantly lower than that in the ADAG trial (21).”
What the sources say
- Not checked yetcites [21] Diabetes Research in Children Network (DirecNet) Study Group, 2008, Relationship of A1C to glucose concentrations in children with type 1 diabetes: assessments by high-frequency glucose determinations by sensors, Diabetes Care source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Other measures of average glycemia such as fructosamine and 1,5-anhydroglucitol are available, but their translation into average glucose levels and their prognostic significance are not as clear as for A1C and CGM.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Discordant results between BGM/CGM and A1C can be the result of the conditions outlined above or glycemic variability, with BGM missing the extremes.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
In the paper
“As stated in the recommendations, time in range (TIR) is a useful metric of glycemic control and glucose patterns, and it correlates well with A1C in most studies (24)(25)(26)(27)(28)(29).”
What the sources say
- Not checked yetcites (24)(25)(26)(27)(28)(29)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“they include crosssectional data and cohort studies (30)(31)(32) demonstrating TIR as an acceptable end point for clinical trials moving forward and that it can be used for assessment of glycemic control.”
What the sources say
- Not checked yetcites (30)(31)(32)
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Published data from two retrospective studies suggest a strong correlation between TIR and A1C, with a goal of 70% TIR aligning with an A1C of 7% (8,26).”
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These analyses also suggest that further lowering of A1C from 7 to 6% (53 mmol/mol to 42 mmol/mol) is associated with further reduction in the risk of microvascular complications, although the absolute risk reductions become much smaller.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The glycemic control comparison in ACCORD was halted early due to an increased mortality rate in the intensive compared with the standard treatment arm (1.41% vs. 1.14% per year; hazard ratio 1.22 [95% CI 1.01-1.46]),with a similar increase in cardiovascular deaths.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Similar to the DCCT/EDIC, after 10 years of observational followup, those originally randomized to intensive glycemic control had significant long-term reductions in MI (15% with sulfonylurea or insulin as initial pharmacotherapy, 33% with metformin as initial pharmacotherapy) and in all-cause mortality (13% and 27%, respectively) (47).”
What the sources say
- Not checked yetcites [47] Holman, 2008, 10-year follow-up of intensive glucose control in type 2 diabetes, N Engl J Med source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The benefit of intensive glycemic control in this cohort with type 1 diabetes has been shown to persist for several decades (55) and to be associated with a modest reduction in all-cause mortality (56).”
What the sources say
- Not checked yetcites [55] Nathan, 2009, Modern-day clinical course of type 1 diabetes mellitus after 30 years’ duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005), Arch Intern Med source
- Not checked yetcites [56] Emerging Risk Factors Collaboration, 2015, Association of cardiometabolic multimorbidity with mortality, JAMA source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“In addition, data from the Swedish National Diabetes Registry (56) and the Joint Asia Diabetes Evaluation (JADE) demonstrate greater proportions of people with diabetes being diagnosed at <40 years of age and a demonstrably increased burden of heart disease and years of life lost in people diagnosed at a younger age (57)(58)(59)(60).”
What the sources say
- Not checked yetcites (57)(58)(59)(60)
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“During the UKPDS, there was a 16% reduction in CVD events (combined fatal or nonfatal MI and sudden death) in the intensive glycemic control arm that did not reach statistical significance (P = 0.052), and there was no suggestion of benefit on other CVD outcomes (e.g., stroke).”
What the sources say
- Not checked yetcites [45] UK Prospective Diabetes Study (UKPDS) Group, 1998, Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34), Lancet source
- Not checked yetcites [46] UK Prospective Diabetes Study (UKPDS) Group, 1998, Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33), Lancet source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Randomized clinical trials examining these agents for cardiovascular safety were not designed to test higher versus lower A1C; therefore, beyond post hoc analysis of these trials, we do not have evidence that it is the glucose lowering by these agents that confers the CVD and renal benefit (53).”
What the sources say
- Not checked yetcites [53] Buse, 2020, Cardiovascular risk reduction with liraglutide: an exploratory mediation analysis of the LEADER trial, Diabetes Care source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: GLP-1 receptor agonists and SGLT2 inhibitors were not approved at the time of the ACCORD, ADVANCE, and VADT trials.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, with longer disease duration, diabetes may become more difficult to control, with increasing risks and burdens of therapy.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“An analysis of data from 470 participants in the ADAG study (237 with type 1 diabetes and 147 with type 2 diabetes) found that the glucose ranges highlighted in Table 6.1 are adequate to meet targets and decrease hypoglycemia (14).”
What the sources say
- Not checked yetcites [14] Wei, 2014, Empirically establishing blood glucose targets to achieve HbA1c goals, Diabetes Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Recurrent level 2 hypoglycemia and/or level 3 hypoglycemia is an urgent medical issue and requires intervention with medical treatment plan adjustment, behavioral intervention, and, in some cases, use of technology to assist with hypoglycemia prevention and identification (76,(79)(80)(81)(82).”
What the sources say
- Not checked yetcites [76] Ghandi, 2021, A comparison of validated methods used to assess impaired awareness of hypoglycaemia in type 1 diabetes: an observational study, Diabetes Ther source
- Not checked yetcites [79] Amiel, 2022, A parallel randomised controlled trial of the Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised self-care (HARPdoc), Nat Commun source
- Not checked yetcites [80] Khunti, 2017, Impact of hypoglycaemia on patient-reported outcomes from a global, 24-country study of 27,585 people with type 1 and insulin-treated type 2 diabetes, Diabetes Res Clin Pract source
- Not checked yetcites [81] Choudhary, 2018, Hypoglycaemia in type 1 diabetes: technological treatments, their limitations and the place of psychology, Diabetologia source
- Not checked yetcites [82] Hopkins, 2012, Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: the U.K. DAFNE experience, Diabetes Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Hypoglycemia is reversed by administration of rapid-acting glucose or glucagon.”
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Hypoglycemia can cause acute harm to the person with diabetes or others, especially if it causes falls, motor vehicle accidents, or other injury.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“These data prompted the revision in the ADArecommended premeal glucose target to 80-130 mg/dL (4.4-7.2 mmol/L) but did not affect the definition of hypoglycemia.”
What the sources say
- Not checked yetcites [14] Wei, 2014, Empirically establishing blood glucose targets to achieve HbA1c goals, Diabetes Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because many people with diabetes demonstrate impaired counterregulatory responses to hypoglycemia and/or experience hypoglycemia unawareness, a measured glucose level <70 mg/dL (3.9 mmol/L) is considered clinically important (independent of the severity of acute hypoglycemic symptoms).”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Level 3 hypoglycemia may be recognized or unrecognized and can progress to loss of consciousness, seizure, coma, or death.”
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“A blood glucose concentration of 70 mg/dL (3.9 mmol/L) has been recognized as a threshold for neuroendocrine responses to falling glucose in people without diabetes.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“BGM and, for some individuals, CGM are essential tools to assess therapy and detect incipient hypoglycemia.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Teaching people with diabetes to balance insulin use and carbohydrate intake and physical activity are necessary, but these strategies are not always sufficient for prevention (77,(103)(104)(105).”
What the sources say
- Not checked yetcites [77] Li, 2019, Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes, Diabetes Obes Metab source
- Not checked yetcites [103] Stanton-Fay, 2021, The DAFNEplus programme for sustained type 1 diabetes self management: intervention development using the Behaviour Change Wheel, Diabet Med source
- Not checked yetcites [104] Farrell, 2021, Clinical approaches to treat impaired awareness of hypoglycaemia, Ther Adv Endocrinol Metab source
- Not checked yetcites [105] Cox, 1994, Long-term follow-up evaluation of blood glucose awareness training, Diabetes Care source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In addition to traditional glucagon injection powder that requires reconstitution prior to injection, intranasal glucagon and ready-toinject glucagon preparations for subcutaneous injection are available and may be beneficial in view of safety, efficacy, and ease of use.”
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Individualized glucose targets, patient education, nutrition intervention (e.g., bedtime snack to prevent overnight hypoglycemia when specifically needed to treat low blood glucose), physical activity management, medication adjustment, glucose monitoring, and routine clinical surveillance may improve patient outcomes (94).”
What the sources say
- Not checked yetcites [94] Seaquist, 2013, Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society, Diabetes Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Added fat may retard and then prolong the acute glycemic response.”
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“An individual does not need to be a health care professional to safely administer glucagon.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“For people with type 1 diabetes with level 3 hypoglycemia and hypoglycemia unawareness that persists despite medical treatment, human islet transplantation may be an option, but the approach remains experimental (96,97).”
What the sources say
- Not checked yetcites [96] Hering, 2016, Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia, Diabetes Care source
- Not checked yetcites [97] Harlan, 2016, Islet transplantation for hypoglycemia unawareness/severe hypoglycemia: caveat emptor, Diabetes Care source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Hypoglycemia may increase the risk of harm to self or others, such as when driving.”
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The use of glucagon is indicated for the treatment of hypoglycemia in people unable or unwilling to consume carbohydrates by mouth.”
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This syndrome is characterized by deficient counterregulatory hormone release, especially in older adults, and a diminished autonomic response, which are both risk factors for and caused by hypoglycemia.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Regardless of the factors contributing to hypoglycemia and hypoglycemia unawareness, this represents an urgent medical issue requiring intervention.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“Hence, individuals with one or more episodes of clinically significant hypoglycemia may benefit from at least short-term relaxation of glycemic targets and availability of glucagon (107).”
What the sources say
- Not checked yetcites [107] Mitchell, 2016, Glucagon prescription patterns in patients with either type 1 or 2 diabetes with newly prescribed insulin, Endocr Pract source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To date, there have been a number of randomized controlled trials in adults with type 1 diabetes and studies in adults and children with type 1 diabetes using realtime CGM (see Section 7, “Diabetes Technology”).”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These studies had differing A1C at entry and differing primary end points and thus must be interpreted carefully.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Stressful events (e.g., illness, trauma, surgery) may worsen glycemic control and precipitate diabetic ketoacidosis or nonketotic hyperglycemic hyperosmolar state, life-threatening conditions that require immediate medical care to prevent complications and death.”
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“In a single study using intermittently scanned CGM, adults with type 1 diabetes with A1C near goal and impaired awareness of hypoglycemia demonstrated no change in A1C and decreased level 2 hypoglycemia (115).”
What the sources say
- Not checked yetcites [115] Reddy, 2018, A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with Type 1 diabetes and impaired awareness of hypoglycaemia, Diabet Med source
Strength:boosted· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Infection or dehydration are more likely to necessitate hospitalization of individuals with diabetes versus those without diabetes.”
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Any condition leading to deterioration in glycemic control necessitates more frequent monitoring of blood glucose; ketosis-prone patients also require urine or blood ketone monitoring.”
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“If accompanied by ketosis, vomiting, or alteration in the level of consciousness, marked hyperglycemia requires temporary adjustment of the treatment plan and immediate interaction with the diabetes care team.”
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The patient treated with noninsulin therapies or medical nutrition therapy alone may require insulin.”
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper relies on this without support.
A1C reflects average glycemia over approximately 3 months.
“A1C reflects average glycemia over approximately 3 months.”
The paper relies on this without support.
The A1C test is an indirect measure of average glycemia and is subject to limitations.
“The A1C test is an indirect measure of average glycemia and, as such, is subject to limitations.”
The paper relies on this without support.
A1C does not provide a measure of glycemic variability or hypoglycemia.
“A1C does not provide a measure of glycemic variability or hypoglycemia.”
The paper relies on this without support.
A1C assays are available that do not demonstrate a statistically significant difference in individuals with hemoglobin variants.
“A1C assays are available that do not demonstrate a statistically significant difference in individuals with hemoglobin variants.”
The paper relies on this without support.
Other A1C assays have statistically significant interference, but the difference is not clinically significant.
“Other assays have statistically significant interference, but the difference is not clinically significant.”
The paper relies on this without support.
GLP-1 receptor agonists and SGLT2 inhibitors were not approved at the time of the ACCORD, ADVANCE, and VADT trials.
“glucagon-like peptide 1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors were not approved at the time of these trials.”
The paper relies on this without support.
Diabetes is a chronic disease that progresses over decades.
“Diabetes is a chronic disease that progresses over decades.”
The paper relies on this without support.
Postprandial hyperglycemia contributes to elevated A1C levels, with its relative contribution being greater at A1C levels closer to 7%.
“It is clear that postprandial hyperglycemia, like preprandial hyperglycemia, contributes to elevated A1C levels, with its relative contribution being greater at A1C levels that are closer to 7% (53 mmol/mol).”
The paper relies on this without support.
Hypoglycemia is the major limiting factor in the glycemic management of type 1 and type 2 diabetes.
“Hypoglycemia is the major limiting factor in the glycemic management of type 1 and type 2 diabetes.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“This can be because habit formation usually takes 2-3 months [86], and significant HbA1c changes require at least 3 months [87].”
From Digital Health Interventions to Prevent Type 2 Diabetes Mellitus: Systematic Review (2025) · cites this paper as [87]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“One of the critical goals of modern diabetes management remains the achievement of acceptable levels of glycemia to avoid the acute and long-term complications associated with T2DM [9].”
From Digital Interventions for Self-Management of Type 2 Diabetes Mellitus: Systematic Literature Review and Meta-Analysis (2024) · cites this paper as [9]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Reference number 21 is assigned to two different studies
MinorThe reference list assigns number 21 to both a study of glucose concentrations in children with type 1 diabetes and a different study of diabetes screening in a middle-school cohort, making citations to (21) ambiguous.
“21. Diabetes Research in Children Network (DirecNet) Study Group. Relationship of A1C to glucose concentrations in children with type 1 diabetes: assessments by high-frequency glucose determinations by sensors.”
“21. Buse JB, Kaufman FR, Linder B, Hirst K, El Ghormli L; HEALTHY Study Group. Diabetes screening with hemoglobin A(1c) versus fasting plasma glucose in a multiethnic middle-school cohort.”
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Association of Sickle Cell Trait With Hemoglobin A1c in African Americans
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Clinical inertia—time to reappraise the terminology?
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Relationship of A1C to Glucose Concentrations in Children With Type 1 Diabetes
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Empirically establishing blood glucose targets to achieve HbA1c goals
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Self-citationRacial Disparity in A1C Independent of Mean Blood Glucose in Children With Type 1 Diabetes
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Selvin, E. (2016) · Diabetes Care · doi:10.2337/dc16-0042 · Cited by 96
Bergenstal, R. M., Johnson, M., Passi, R., Bhargava, A., Young, N., Kruger, D. F., Bashan, E., Bisgaier, S. G., Isaman, D. J. M., & Hodish, I. (2019) · The Lancet · doi:10.1016/s0140-6736(19)30368-x · Cited by 88
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Surveillance of hypoglycemia-limitations of emergency department and hospital utilization data
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Khunti, K., Alsifri, S., Aronson, R., Cigrovski Berković, M., Enters-Weijnen, C., Forsén, T., Galstyan, G., Geelhoed-Duijvestijn, P., Goldfracht, M., Gydesen, H., et al. (2017) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2017.05.004 · Cited by 71
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Frequent monitoring of A1c during pregnancy as a treatment tool to guide therapy
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Continuous glucose monitoring pilot in low-income type 1 diabetes patients
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Clinical recommendations for the use of the ambulatory glucose profile in diabetes care
Kröger, J., Reichel, A., Siegmund, T., & Ziegler, R. (2020) · Journal of Diabetes Science and Technology · doi:10.1177/1932296819883032 · Cited by 51
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Kittleson, M. M., Panjrath, G. S., Amancherla, K., Davis, L. L., Deswal, A., Dixon, D. L., Januzzi, J. L., & Yancy, C. W. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.03.393 · Cited by 554
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Ebekozien, O. A., Mungmode, A., Sanchez, J. E., Rompicherla, S., Demeterco‐Berggren, C., Weinstock, R. S., Jacobsen, L. M., Davis, G. M., McKee, A. M., Aktürk, H. K., et al. (2023) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2023.0320 · Cited by 214
Weekly Icodec versus Daily Glargine U100 in Type 2 Diabetes without Previous Insulin
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Gallardo-Gómez, D., Salazar-Martínez, E., Alfonso-Rosa, R. M., Ramos-Munell, J., del Pozo-Cruz, J., del Pozo Cruz, B., & Álvarez-Barbosa, F. (2024) · Diabetes Care · doi:10.2337/dc23-0800 · Cited by 137
Metadata
- Authors
- 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., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C., & Gabbay, R. A.
- ORCID
- ElSayed, Nuha A.
- Aleppo, Grazia
- Aroda, Vanita R.
- Bannuru, Raveendhara R.
- Brown, Florence M.
- Bruemmer, Dennis
- Collins, Billy S.
- Hilliard, Marisa E.
- Isaacs, Diana
- Johnson, Eric L.
- Kahan, Scott
- Khunti, Kamlesh
- Lyons, Sarah K.
- Perry, Mary Lou
- Prahalad, Priya
- Pratley, Richard E.
- Seley, Jane Jeffrie
- Stanton, Robert C.
- Gabbay, Robert A.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2022-12-12
- Volume
- 46
- Issue
- Supplement_1
- Pages
- S97-S110
- ISSN
- 0149-5992 (ISSN-L)
- PMC
- PMC9810469
- OpenAlex
- W4311158234
- Semantic Scholar
- 6be81498eb5426b9aadb2bc1d684bc2e4062b4af
- Cited by
- 684
- References
- 136
- Citations by year
- 2026: 77 · 2025: 170 · 2024: 269 · 2023: 168
- FWCI
- 21.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- glycemic targets, diabetes management, American Diabetes Association standards of care, clinical guidelines, quality of care, treatment goals, level of evidence
- MeSH terms
- Diabetes Mellitus, Endocrinology, Humans, Reference Standards, Societies, Medical, Standard of Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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