Hemoglobin A1c Targets :A Guidance Statement Update From the American College of Physicians

[sandybrown]

Healthline email:

New Diabetes Recommendations Challenge Decades-Old Guidelines.

I read the below 4 points on this link:

annals.org/aim/fullarticle/...

Guidance statement 2 is confusing me!

"Guidance Statement 1:

Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care.

Guidance Statement 2:

Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.

Guidance Statement 3:

Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%.

Guidance Statement 4:

Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population."

[ramana42 Volunteer]

The significance is,any one above 80 is likely to survive another 5 years at best.So,why all the struggle to lower A1c to around 6?If he has managed without complications thus far,it is unlikely that complications will set in and become a real problem in the remaining few years left.

[mrjoe in reply to ramana42]

You are right.........My doctor has told me that at age 70 if your a1c is 7 and at age 80, if it is 8, do not worry, you are OK. Just try to keep between 7 and 8

[bnsbhat]

One of the more comprehensive guidelines.

[don9999]

What I understand from this, is as under, pl correct if its wrong:

1. If you are on medication and your A1c is between 7 to 8, then there is no need of more medications.

2. If you have controlled your A1c by diet and exercise (life style changes) and your A1c is between 7 to 8, then you need no medication, because pushing A1c below it by medication, have more harm than good.

3. If your A1c has fallen below 6.5 and you are on medication, then try to reduce medicines.

4. Senior patients (may be 70+) should be treated on actual problems they are facing.

[mrjoe in reply to don9999]

Statement 1 is correct............If you ar e above 6o years, you are ok with a1c of 7 to 8 . Do not take medication to lower below 7

[sandybrown in reply to mrjoe]

Thanks, I have been reading this new guide line for nearly two weeks but no one agreed with the new guide line, well you are in the age group to answer this question.

I like to find out when this new guide line came about. Four years age I was looking after a relating, mid 85, after an operation he was on tube feed and daily blood glucose increased and he was put on insulin pump for 24 hours!

I am always learning, thanks.

[Venkat-1810]

Stmt 2 and 3 are contradictory

[DIAINDIA]

I am 57, my HBA1C IS 8, I am under medication of 1GM OF Metfornin in the mornig & 500mg in the Evening, I take only 2 MEALS A day. Any body can suggest better ways

[sandybrown]

You need to put this question to your doctor to look at the dosage?

If you are only taking two meals a day what is the time difference between meals?

Give examples of your two meals, you need to watch out for free and hidden sugar in all your food and drinks, regular exercise. Do you go for regular eye check, foot check and blood test? What are your cholesterol levels?