ACP urges less aggressive drug treatment for type 2 diabetes
The American College of Physicians (ACP) recommends a hemoglobin A1c (HbA1c) target between 7 and 8 percent for most patients with type 2 diabetes, according to a March 6 guidance statement update in the Annals of Internal Medicine.
That recommendation is in contrast to some existing guidelines from national organizations which recommend a range of 6.5 to 7 percent, just above the 6.5 percent HbA1c threshold indicating diabetes.
“ACP’s analysis of the evidence behind existing guidelines found that treatment 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 Jack Ende, MD, president of the 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 low blood sugar, medication burden, and costs.”
Consistent with the ACP’s overall recommendation to use more moderate blood sugar targets, the authors of the guidance statement suggested clinicians scale back medications for patients who achieve a HbA1c of less than 6.5 percent.
“Results from studies included in all the guidelines demonstrate that health outcomes are not improved by treating to A1C levels below 6.5 percent,” 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.”
The authors arrived at their recommendations after a search of existing guidelines related to HbA1c targets for treating type 2 diabetes. They analyzed and critiqued the methodology of each one, as well as five long-term randomized clinical trials that were crucial in creating those guidelines. However, the ACP statement authors didn’t perform their own review of all existing evidence.
For patients with a life expectancy of less than 10 years due to advanced age (80 or older) or chronic conditions, the authors recommended clinicians treat patients to alleviate symptoms rather than hit a specific blood sugar target. Drug therapy to reach a certain HbA1c level in this population may do more harm than good, the researchers noted.
Ende pointed out the guideline statement focused on drug therapy. Lower targets may be more appropriate if the patient is able to supplement or replace medication with lifestyle modifications like diet and exercise.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.