Type 2 Diabetes Mellitus: ACP Releases Updated Guidance Statement on A1C Targets for Pharmacologic Glycemic Control

 

Am Fam Physician. 2018 Nov 1;98(9):613-614.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Goals of glycemic control should be individualized to each patient, after discussing harms and benefits, preferences, overall health status, treatment burden, and expense.

• An A1C target of 7% to 8% is recommended for most patients, because targets of 7% or less do not appear to result in reduced risk of mortality or macrovascular events.

• The medication regimen may be de-escalated in patients with an A1C level less than 6.5%, because there is no evidence of clinical benefit in patients at this level.

From the AFP Editors

More than 9% of persons in the United States have type 2 diabetes mellitus. Increased blood glucose levels in these patients can lead to polyuria, polydipsia, weight loss, and dehydration. Although lowering blood glucose levels can decrease the risk of these symptoms and the associated complications, there are still disadvantages to doing so, including adverse effects, increased treatment burden, and expense.

A1C measurement is one method for determining blood glucose levels, but it is inconsistent and can change based on a patient's race and ethnicity. Previous guidelines have recommended the use of medications to reach A1C targets; however, an ideal target remains debatable. This guidance statement from the American College of Physicians (ACP) aims to help physicians achieve appropriate A1C targets via medication for nonpregnant patients with type 2 diabetes based on a review of six health care organization guidelines. In a review of these guidelines, the authors found no studies indicating that A1C targets less than 6.5% improve clinical outcomes. Moreover, using medication to achieve this level had associated harms.

Guidance Statements

Goals of glycemic control via medication should be individualized to each patient, after talking about benefits and harms of more vs. less control, preferences, overall health status, treatment burden, and expense. Because targets of 7% or less vs. approximately 8% do not appear to result

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

Copyright © 2018 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Jun 15, 2019

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article