Today I am going to talk about the American College of Physicians (ACP) guidelines for glycated hemoglobin (A1c) treatment targets in patients with type 2 diabetes.[1] Before I continue, I should tell you that I disagree with what they say. All of the major organizations that involve endocrinologists in this country also disagree with what they have to say. But I am not just going to be argumentative. I am going to discuss ways in which I believe they are correct and ways in which I believe they are incorrect.
The first point in the guideline is that you should individualize targets, and I can't agree more. Every patient deserves an individualized target.
The next three recommendations, however, go way off the rails. [Editor's Note: These recommend setting most A1c targets between 7% and 8%, scaling back treatment when A1c drops below 6.5%, and avoiding A1c targets altogether in elderly and chronically ill patients where harms might outweigh benefits.][1] I say this because the ACP used six other guidelines to create their own, and I believe that they looked at studies incorrectly and drew conclusions that are not germane to the way we treat patients with type 2 diabetes today.
Type 2 Diabetes Mellitus
Type 2 Diabetes Mellitus Clinical Practice Guidelines (SID/AMD, 2022)
Pediatric Type 2 Diabetes Mellitus
COMMENTARY
New Diabetes Guidelines Already Outdated?
Anne L. Peters, MD
DisclosuresApril 12, 2018
Today I am going to talk about the American College of Physicians (ACP) guidelines for glycated hemoglobin (A1c) treatment targets in patients with type 2 diabetes.[1] Before I continue, I should tell you that I disagree with what they say. All of the major organizations that involve endocrinologists in this country also disagree with what they have to say. But I am not just going to be argumentative. I am going to discuss ways in which I believe they are correct and ways in which I believe they are incorrect.
The first point in the guideline is that you should individualize targets, and I can't agree more. Every patient deserves an individualized target.
The next three recommendations, however, go way off the rails. [Editor's Note: These recommend setting most A1c targets between 7% and 8%, scaling back treatment when A1c drops below 6.5%, and avoiding A1c targets altogether in elderly and chronically ill patients where harms might outweigh benefits.][1] I say this because the ACP used six other guidelines to create their own, and I believe that they looked at studies incorrectly and drew conclusions that are not germane to the way we treat patients with type 2 diabetes today.
Medscape Diabetes © 2018 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Anne L. Peters. New Diabetes Guidelines Already Outdated? - Medscape - Apr 12, 2018.
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Authors and Disclosures
Authors and Disclosures
Author(s)
Anne L. Peters, MD
Professor, Keck School of Medicine; Director, University of Southern California Westside Center for Diabetes, University of Southern California, Los Angeles, California
Disclosure: Anne L. Peters, MD, has disclosed the following relevant financial relationships:
Serve(d) on the advisory board for: Abbott Diabetes Care; Becton Dickinson; Bigfoot Biomedical; Boehringer Ingelheim Pharmaceuticals, Inc.; Eli Lilly and Company; Lexicon Pharmaceuticals, Inc.; Livongo; Medscape; Merck & Co., Inc.; Novo Nordisk; Omada Health; sanofi-aventis; Science 37
Received research support from: Dexcom; MannKind Corporation
Serve(d) as a member of a speakers bureau for: Novo Nordisk