The American College of Physicians (ACP) recently issued new guidelines aimed at assisting clinicians in making decisions about targets when using pharmacologic therapy in adults with type 2 diabetes.
The American College of Physicians (ACP) recently issued new guidelines aimed at assisting clinicians in making decisions about targets when using pharmacologic therapy in adults with type 2 diabetes.1
Based on evaluation of existing guidelines and clinical studies, the ACP has recommended that clinicians use less intensive treatment target strategies. Studies showed no evidence that lowering HbA1c levels less than 7% provided any additional benefit. The guidelines also suggested de-intensifying treatment for patients with HbA1c levels persistently below 6.5%.
“The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7% and 8% will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs,” said Jack Ende, MD, President, ACP, in a press release.2
The ACP published the 4 evidence-based statement guidelines to assist health care providers in making treatment decisions:
The authors analyzed 5 large, long-term controlled trials from existing guidelines that investigated intensive versus less intensive treatment target strategies in adults. Throughout the studies, patients randomly assigned to more intensive therapy required more antiglycemic medications at higher doses, leading to more adverse events than the less intensive groups.
According to the guidelines, the studies demonstrated that no evidence has consistently shown that intensive glycemic control to HbA1c levels below 7% reduces clinical microvascular events, and that only reductions were seen in surrogate microvascular complications.
“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.2
Although several guidelines differ on recommended treatment target strategies, all guidelines consistently recommend individualizing HbA1c targets on the basis of patient characteristics, such as comorbid conditions and risk for hypoglycemia.