Revisiting Glycemic Control Targets: Survival Outcomes by Glycated Hemoglobin Levels Among Patients With Diabetes Under Contemporary Antidiabetic Therapy

Journal of the American Heart Association, Volume 15, Issue 10 , May 19, 2026. BackgroundOptimal glycated hemoglobin (HbA1c) targets for type 2 diabetes remain controversial.

Given the evolution of modern antidiabetic therapies, this study aims to reevaluate optimal glycemic targets among patients receiving contemporary glucose‐lowering treatments.MethodsWe conducted a retrospective cohort study using the National Taiwan University Hospital Integrated Medical Database, including 16 604 patients with type 2 diabetes who initiated dipeptidyl peptidase‐4 inhibitors between 2009 and 2019, with follow‐up through December 2021. Patients were categorized by long‐term mean HbA1c quintiles.

Outcomes included major adverse cardiovascular events (including ischemic stroke, myocardial infarction, cardiovascular death), renal outcomes (progression to dialysis, ≥50% estimated glomerular filtration rate decline, or doubling serum creatinine), hospitalization for heart failure, and safety outcomes. Associations were assessed using Cox proportional hazards models and restricted cubic spline analyses.ResultsCompared with the third quintile as reference, the fourth (hazard ratio [HR], 1.22 [95% CI, 1.01–1.47]) and fifth quintiles (HR, 1.36 [95% CI, 1.12–1.64]) were associated with a significantly higher risk of major adverse cardiovascular events.