Relaxed hemoglobin A1c goals for T2DM from the American College of Physicians

Reference

Qaseem A, Wilt TJ, Kansagara D, et al, for the Clinical Guidelines Committee of the American College of Physicians. Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ann Intern Med 2018;168(8):569-576.

Synopsis

These authors followed good practices for developing guidelines. They focused on the benefits and harms of treatment and based their recommendations on outcomes from studies of outpatient adults with type 2 diabetes. They obtained the research after a systematic review of the available literature, graded the evidence, and included both a methodologist and a patient representative unencumbered by relationships with pharma. Voting members did not have financial conflicts of interest. As with recent changes to recommendations from the American Diabetes Association, they suggest basing glycemic goals on patient wishes, not hard-and-fast targets, following a discussion of benefits and harms. For most patients, an A1c level between 7% and 8% is suitable. In a direct smackdown to recommendations from US endocrinologist societies (Endocr Pract 2018;24(1):91-120), they suggest backing off treatment if a patient's A1c level is below 6.5%, to avoid hypoglycemic symptoms. With a nod toward other preventions aimed at baseline risk, they suggest tossing glycemic targets and treating to minimize symptoms related to hyperglycemia in patients 80 years or older or with other chronic diseases and/or a life expectancy of fewer than 10 years.