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.



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