The American Diabetes Association has responded with ‘deep’ concern to a recent hemoglobin A1C target guidance authored by the American College of Physicians (ACP). 

The ACP guidance states that for ‘most’ diabetes patients, clinicians should aim to achieve an HbA1c level of between 7 to 8%. In their response, the ADA has called the target ‘not reflective of the long-term benefits of lower A1C targets’. Although the ADA agrees with many areas of the ACP guidance, there are several significant areas that differentiate from the ADA’s 2018 Standards of Care. 

Based on international clinical trials (ACCORD, ADVANCE, VADT and UKPDS), the ADA recommends a reasonable A1C goal for adults with type 2 diabetes of ≤7%. The ACP guidance does not consider the long-term benefits of lower A1C targets, which can reduce diabetes complications, says the ADA. Contrary to this, the ACP guidance states that for patients who achieve HbA1c levels of ≤6.5%, clinicians should consider deintensifying pharmacologic therapy. 

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In patients of advanced age, both organizations generally agree on end-of-life recommendations, however the ADA disagrees with the ACP recommendation that HbA1c targets should be avoided in patients with a life expectancy of ≤10 years (≥80 years old), residence in nursing homes, or in those with chronic conditions. The ADA states that each case should be considered 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.’

“By lumping ‘most’ people with type 2 diabetes into a 7 to 8 percent target range, ACP’s new guidance could cause increased complication rates for those who may safely benefit from lower evidence-based targets,” said ADA’s Chief Scientific Officer, William T. Cefalu, MD.

In addition to the ADA, the American Association of Clinical Endocrinologists (AACE), the American Association of Diabetes Educators (AADE), and the Endocrine Society have all released statements ‘strongly’ disagreeing with the ACP guidance.

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