American Diabetes Association issues new guidance, “Hemoglobin A1C Targets for Glycemic Control with Pharmacologic Therapy for Nonpregnant Adults with Type 2 Diabetes Mellitus”

The American Diabetes Association issues new guidance, “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,” that was published in the Annals of Internal Medicine.

American College of Physicians’ enlists several topics on statement of agreement and there are several remarkable areas that do not align with ADA’s 2018 Standards of Medical Care in Diabetes. The American Diabetes Association has published the annual Standards of Care since 1989, the global resource for the optimal treatment and prevention of diabetes and diabetes-related complications.

The ADA has long recommended that treatment goals be individualized based on factors both modifiable and nonmodifiable suuch as the age, life expectancy, duration of disease, resources and support, and comorbid conditions. The ADA recommends that a reasonable A1C goal for many nonpregnant adults with type 2 diabetes is less than 7 percent based on the available evidence to date from the ACCORD, ADVANCE, VADT and UKPDS international clinical trials.

ACP’S  new guidance does not take into account the optimistic legacy effects of intensive blood glucose control confirmed in multiple clinical trials and therefore are not relfective of the long-term benefits of  lower A1C targets. There is clear, convincing evidence of a long-term reduction in diabetes complications with A1Cs at and below 7 percent. ADA is also concerned by the missing consideration of the positive impact of several newer medication classes (SGLT2 inhibitors and GLP-1 receptor agonists) that are associated with low risk for hypoglycemia, have favorable effects on weight and improved cardiovascular disease outcomes.

DA’s Chief Scientific, Medical and Mission Officer William T. Cefalu, MD. “Individualization of targets is the key factor in designing the most appropriate regimen for patients with Type 2 diabetes. However, by lumping ‘most’ people with type 2 diabetes into a 7 to 8 percent target range, ACP’s new guidance could cause increased complication rates for those who may safely benefit from lower evidence-based targets. Multiple clinical trials confirm increased additional risk of complications among patients who are above an A1C of 7 percent.”