ACP Update: HbA1c Targets for Glycemic Control in Type 2 Diabetes
Clinicians should personalize glycemic control goals; aim for HbA1c of 7 to 8% for most adults.
(HealthDay News) -- Guidance has been developed for hemoglobin A1c (HbA1c) targets for glycemic control among nonpregnant adults with type 2 diabetes; the guidance statement was published online in the Annals of Internal Medicine.
Amir Qaseem, MD, PhD, from the American College of Physicians in Philadelphia, and colleagues reviewed and evaluated guidelines that addressed HbA1c targets for treating type 2 diabetes in nonpregnant outpatient adults.
The authors developed four guidance statements relating to HbA1c targets. For patients with type 2 diabetes, clinicians should personalize goals for glycemic control based on discussion of benefits and harms of pharmacotherapy, patient preference, patient general health and life expectancy, treatment burden, and costs of care. In most patients with type 2 diabetes, clinicians should aim to achieve an HbA1c level of between 7 to 8%. In patients with type 2 diabetes who achieve HbA1c levels below 6.5%, clinicians should consider deintensifying pharmacologic therapy. In patients with a life expectancy of less than 10 years due to advanced age, residence in a nursing home, or chronic conditions, clinicians should focus treatment on minimizing hyperglycemia-related symptoms and avoid targeting an HbA1c level because the harms outweigh the benefits in this population.
"This statement focuses on the benefits and harms of targeting lower versus higher HbA1c levels and does not cover use of specific medications outside of their use to achieve HbA1c target," the authors write.
One author disclosed financial ties to Healthwise. Two authors were recused from voting on the recommendations for an active direct and an active indirect financial conflict.
Qaseem A, Wilt TJ, Kansagara D, et al. Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians. Ann Intern Med. 2018. DOI: 10.7326/M17-0939