The American College of Physicians (ACP), a national organization of internal medicine doctors has come up with new guidance on managing type 2 diabetes. This includes relaxing the long-term blood sugar target called hemoglobin A1C.
The A1C is a blood test that gives an average estimate of one’s blood sugar IQ level over the past few months. For most adults, the American Diabetes Association recommends a target A1C of below 7%. However this percentage may vary based on individual circumstances.
The new ACP guidance suggests that A1C should be between 7% and 8% for most adults with type type 2 diabetes while adults who achieve an A1C below 6.5% are advised to step down their diabetes treatment to keep the level from going even lower.
According to the ACP type 2 diabetes management goals should be personalized based on the benefits and risks of medications, patient preference, general health status and life expectancy.
The ACP therefore advised; “These changes should in no way be interpreted as diabetes is unimportant,” said Dr. Jack Ende, ACP’s president.
Dr. William Cefalu, the American Diabetes Association (ADA) Chief scientific, medical and mission officer speaking on the new guideline stated that the ADA also recognizes the importance of individualizing diabetes treatments but also expresses concern about loosening the A1C target.
“The ADA believes all people diagnosed with type 2 diabetes can be healthy and should have the opportunity to reduce their risk of serious diabetes complications through appropriate blood glucose targets,” Cefalu said.
According to Cefalu, if people safely achieve an A1C of 6.5% or less, it is of no use to arbitrarily reduce their medication. If people are experiencing low blood sugar levels, then medications should likely be adjusted. He rather posits that there’s no lower limit on A1C as long as people have minimal risk of low blood sugar.
However, Cefalu stated that the ADA recommends individualized therapy. He noted that the average life expectancy for someone who reaches 80 years old is another 8 years for men and 10 years for women.
“Each specific case should be evaluated individually, as a person living in a nursing home or with a chronic condition may yet have some years to live, and would likely prefer to live them without diabetes complications,” Dr. Cefalu added.