The WHO PEN (Package of Essential Noncommunicable Disease Interventions) protocol recommends that most people with diabetes aim for an HbA1c of 7.0% (53 mmol/mol). If HbA1c measurement is not available, a target fasting blood glucose of ≤7 mmol/L (126 mg/dl) and a postprandial plasma glucose of ≤9 mmol/L (45) can serve as surrogates. However, an individualized approach is encouraged in setting the patient’s target level for glycaemic control, taking into account their comorbidities, risks from medication side-effects and likely benefit from tight glycaemic control in view of life expectancy. Individualized care

• The low certainty evidence identified through the review challenges the assumption that stricter glycaemic control always leads to better outcomes. In type 1 diabetes, tight control may increase harm (hypoglycaemia), highlighting the need for individualized targets that balance safety, benefits and resource use. In addition, the use of an individualized target allows for consistency in approach and ease of use in clinical practice. Other considerations include the woman’s values and preferences, her ability to manage a hypoglycaemic event, and her access to health care. New technologies
• Available technologies for glucose monitoring and control differ between high-income and low-income settings. In all contexts, the training that health-care providers can access will influence the technologies they are able to recommend.