The student looks for "the one target for T2DM". There is none. There are three scales, and each has its own evidence history.
Glycaemia. ADA 2026 Recommendation 6.3a: an HbA1c target <7% (<53 mmol/mol) is appropriate for many non-pregnant adults without severe hypoglycaemia and without hypoglycaemia that disrupts their life (level A). Lower, for example <6.5% (<48 mmol/mol), may be considered in people in good health, with preserved function and low treatment risk (6.4, level B). Less stringent targets apply with cognitive and functional limitations, frailty, severe comorbidities, or when the harm of treatment, including hypoglycaemia, outweighs the benefit (6.5). For CGM: time in range (TIR) >70% for many non-pregnant people; time below range (TBR) <3.9 mmol/L <4% (<1% in older adults) and time <3.0 mmol/L <1% (6.3b, 6.3c).
The MoH RK 2022 protocol individualises more strictly by age and ASCVD (Table 5): young without ASCVD and without risk of severe hypoglycaemia — <6.5%; middle-aged — <7.0%; older without dementia — <8%; with senile dementia — <8.5%; with ASCVD or risk of severe hypoglycaemia, targets shift up by 0.5 points in the young and middle-aged. With a life expectancy <5 years, targets may be less stringent. The protocol gives the glucose values corresponding to these HbA1c levels in Table 6: for HbA1c <7.0, fasting <7.0 and postprandial <9.0 mmol/L.
Why 6.0% cannot be set for everyone. ACCORD has already been discussed: in a population at high cardiovascular risk the <6.0% target increased mortality. UKPDS 33 showed the microvascular benefit of moderate intensification in the newly diagnosed. The two trials do not contradict each other — they are about different people.
Blood pressure. ADA 2026: <130/80 if safe; encourage systolic <120 in high cardiovascular or renal risk (10.4). MoH RK 2022 protocol: windows of 120–129 / 70–79 up to age 65 and systolic 130–139 after 65. The lower bound of "not below 120" in the RK protocol is protection against hypoperfusion; ADA 2026, on the contrary, encourages <120 for high risk. This is a divergence between editions, not "someone being absolutely wrong". In a teaching task from an RK outpatient clinic, protocol No. 158 is cited; in a discussion of international management, ADA 2026.
Lipids. MoH RK 2022 protocol: LDL <2.6 / <1.8 / <1.4 mmol/L by risk grade, or a 50% reduction at very high risk. A statin is the foundation. ADA 2026 no longer supports adding a fibrate "on top of a statin for everyone with diabetes" as a cardiovascular strategy (10.32).
How often to review the glucose-lowering regimen. MoH RK 2022 protocol: HbA1c every 3 months; change of regimen if individual targets are not achieved — no later than 3–6 months. ADA 2026: reassess the plan every 3–6 months (9.14); do not delay intensification or deintensification (9.15). Therapeutic inertia is not "caution" but the loss of the UKPDS microvascular window.
Hypoglycaemia as a limiter. When adding a new drug, review the doses of sulfonylureas, glinides and insulin (9.17). Do not combine a dipeptidyl peptidase-4 (DPP-4) inhibitor with a GLP-1 agonist or a dual GIP/GLP-1 agonist: there is no additional glycaemic benefit (9.18, level B).
The conclusion. The target is not a number from the middle of a table. The target is a number that this person can carry without severe hypoglycaemia, plus BP and LDL, without which glycaemic control leaves the large vessels exposed.