ACP recommends moderate blood sugar control targets for most patients with type 2 diabetes

March 5, 2018, American College of Physicians
Credit: CC0 Public Domain

Patients with type 2 diabetes should be treated to achieve an A1C between 7 percent and 8 percent rather than 6.5 percent to 7 percent, the American College of Physicians (ACP) recommends in an evidence-based guidance statement published today in Annals of Internal Medicine.

An A1C test measures a person's average level over the past two or three months. An A1C of 6.5 percent indicates diabetes.

"ACP's analysis of the evidence behind existing guidelines found that with drugs to targets of 7 percent or less compared to targets of about 8 percent did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms," said Dr. Jack Ende, president, ACP. "The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7 percent and 8 percent will best balance long-term benefits with harms such as , medication burden, and costs."

ACP recommends that clinicians should personalize goals for in patients with type 2 diabetes based on a discussion of benefits and harms of , patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care.

The rationale in guidelines that recommended lower treatment targets (below 7 percent or below 6.5 percent) is that more intensive blood sugar control would reduce microvascular complications over many years of treatment. However, the evidence for reduction is inconsistent and reductions were seen only in surrogate such as the presence of excess proteins in the urine.

If patients with type 2 diabetes achieve an A1C of less than 6.5 percent, ACP recommends that clinicians consider de-intensifying drug therapy by reducing the dosage of current treatment, removing a medication if the patient is currently taking more than one drug, or discontinuing drug treatment.

"Results from studies included in all the guidelines demonstrate that health outcomes are not improved by treating to A1C levels below 6.5 percent," Dr. Ende said. "However, reducing drug interventions for patients with A1C levels persistently below 6.5 percent will reduce unnecessary medication harms, burdens, and costs without negatively impacting the risk of death, heart attacks, strokes, kidney failure, amputations, visual impairment, or painful neuropathy."

ACP also recommends that clinicians should treat patients with type 2 diabetes to minimize symptoms related to high blood sugar rather than targeting an A1C level in patients with a life expectancy less than 10 years due to advanced age (80 years or older) or chronic conditions (such as dementia, cancer, end stage kidney disease, severe COPD or congestive heart failure, and residing in nursing homes), as the harms of A1C targeted treatment outweigh the benefits in this patient population.

"Although ACP's guidance statement focuses on drug therapy to control blood sugar, a lower treatment target is appropriate if it can be achieved with diet and lifestyle modifications such as exercise, dietary changes, and weight loss," said Dr. Ende.

Noting the policy implication of its recommendations, ACP suggests that any physician performance measures developed to evaluate quality of care should not have a target A1C level below 8 percent for any patient population and should not have any A1C targets for older adults (e.g., age 80 and older) or younger individuals with limited because of other serious diseases and illnesses.

More than 30 million Americans have diabetes, and 90 percent to 95 percent of them have type 2 diabetes. Type 2 diabetes most often develops in people over age 45, but more and more children, teens, and young adults are also developing it.

ACP's guidance statements involve a review and methodological critique of existing and sometimes conflicting guidelines rather than a systematic review of available evidence. "Hemoglobin A1C Targets for Glycemic Control with Pharmacologic Therapy in Non-Pregnant Adults with Type 2 Diabetes Mellitus" is derived from an appraisal of selected guidelines from around the world addressing A1C targets in the drug treatment of type 2 .

Explore further: Personalized blood sugar goals can save diabetes patients thousands

Related Stories

Personalized blood sugar goals can save diabetes patients thousands

December 11, 2017
A cost analysis by researchers at the University of Chicago Medicine shows treatment plans that set individualized blood sugar goals for diabetes patients, tailored to their age and health history, can save $13,546 in health ...

Study finds that heart failure is more fatal in patients with type 2 diabetes

November 17, 2017
A new study has found that heart failure patients with pre-existing type 2 diabetes have higher hospitalisation and death rates, but that keeping blood sugars balanced can help lower the risk almost to that of heart failure ...

Many older individuals with type 2 diabetes are over-treated

January 24, 2018
In a recent Diabetes, Obesity & Metabolism analysis of individuals aged 70 years with type 2 diabetes, almost 40% with recommended HbA1c levels (which indicate blood glucose levels) were over-treated.

Endocrine Society experts examine how diabetes harms body's smallest blood vessels

November 8, 2017
The Endocrine Society issued a new Scientific Statement today examining how diabetes damages the body's smallest blood vessels as well as how the condition affects the body's natural repair processes designed to protect the ...

American College of Physicians updates recommendations for treatment of type 2 diabetes

January 2, 2017
Physicians should prescribe metformin to patients with type 2 diabetes when medication is needed to improve high blood sugar, the American College of Physicians (ACP) recommends in an evidence-based clinical practice guideline ...

ADA recommends metformin as the preferred drug treatment for type 2 diabetes

March 13, 2017
The American Diabetes Association (ADA) recommends metformin as the first-line treatment for type 2 diabetes. Metformin monotherapy should be initiated at the time of diagnosis for most patients unless there are contraindications. ...

Recommended for you

Genomic study brings us closer to precision medicine for type 2 diabetes

September 21, 2018
Most patients diagnosed with type 2 diabetes are treated with a "one-size-fits-all" protocol that is not tailored to each person's physiology and may leave many cases inadequately managed. A new study by scientists at the ...

High gluten diet in pregnancy linked to increased risk of diabetes in children

September 19, 2018
A high gluten intake by mothers during pregnancy is associated with an increased risk of their child developing type 1 diabetes, suggests a study published by The BMJ today.

Anti-inflammatory protein promotes healthy gut bacteria to curb obesity

September 19, 2018
Scientists from the UNC School of Medicine discovered that the anti-inflammatory protein NLRP12 normally helps protect mice against obesity and insulin resistance when they are fed a high-fat diet. The researchers also reported ...

Study reveals the current rates of diagnosed type 1 and type 2 diabetes in American adults

September 18, 2018
A new study from the University of Iowa finds that type 2 diabetes remains overwhelmingly the most common type of diabetes diagnosed in American adults who have the disease.

Research reveals link between immunity, diabetes

September 14, 2018
When it comes to diet-induced obesity, your immune system is not always your friend.

BPA exposure in U.S.-approved levels may alter insulin response in non-diabetic adults

September 14, 2018
In a first study of its kind study, researchers have found that a common chemical consumers are exposed to several times a day may be altering insulin release. Results of the study, led by scientists at the University of ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.