New ACP Diabetic Recommendations
Hemoglobin A1c is a blood test used to measure the average blood sugar in diabetics and it gives a rough estimate on how high or low the blood sugar has been over the past 2-3 months.
It is recommended in all diabetics every three months.
The American College of Physicians (ACP) has recently issued a guidance statement on the optimal hemoglobin A1c targets for patients with type 2 diabetes and it was published in the September 18 issue of the Annals of Internal Medicine. They did this partly because there were varying recommendations from different medical specialties.
After reviewing the available guidelines, the ACP committee issued 3 summary statements:
Statement 1: The goal for blood sugar control should be set as low as is feasible to prevent microvascular complications of diabetes, while avoiding undue risk for adverse events or placing an unacceptable burden on patients. Discussing with the patient the risks and benefits of specific levels of glycemic control should precede setting treatment goals.
Based on individualized assessment, a hemoglobin A1c level less than 7% is a reasonable target for many patients, but not for all. Hemoglobin A1c goals higher than 7% may be indicated for patients who are elderly or frail, who are at higher risk for adverse events from tight control, or who have substantially lowered life expectancy from comorbid conditions. More stringent targets may be indicated in patients who are at increased risk for microvascular complications.
Statement 2: Individualized evaluation of risk for complications from diabetes, comorbidity, life expectancy, and patient preferences should determine the specific goal for hemoglobin A1c level.
Statement 3: The ACP committee recommends additional research to evaluate the optimal level of glycemic control, particularly in patients who have significant comorbid conditions.
As with most things in medicine, the ACP reaffirms the “cookbook” approach is not adequate and may be harmful in some patients.
Once again, we have reinforced the belief there is an art of medicine as well as the science of medicine.
It is recommended in all diabetics every three months.
The American College of Physicians (ACP) has recently issued a guidance statement on the optimal hemoglobin A1c targets for patients with type 2 diabetes and it was published in the September 18 issue of the Annals of Internal Medicine. They did this partly because there were varying recommendations from different medical specialties.
After reviewing the available guidelines, the ACP committee issued 3 summary statements:
Statement 1: The goal for blood sugar control should be set as low as is feasible to prevent microvascular complications of diabetes, while avoiding undue risk for adverse events or placing an unacceptable burden on patients. Discussing with the patient the risks and benefits of specific levels of glycemic control should precede setting treatment goals.
Based on individualized assessment, a hemoglobin A1c level less than 7% is a reasonable target for many patients, but not for all. Hemoglobin A1c goals higher than 7% may be indicated for patients who are elderly or frail, who are at higher risk for adverse events from tight control, or who have substantially lowered life expectancy from comorbid conditions. More stringent targets may be indicated in patients who are at increased risk for microvascular complications.
Statement 2: Individualized evaluation of risk for complications from diabetes, comorbidity, life expectancy, and patient preferences should determine the specific goal for hemoglobin A1c level.
Statement 3: The ACP committee recommends additional research to evaluate the optimal level of glycemic control, particularly in patients who have significant comorbid conditions.
As with most things in medicine, the ACP reaffirms the “cookbook” approach is not adequate and may be harmful in some patients.
Once again, we have reinforced the belief there is an art of medicine as well as the science of medicine.
Labels: art of medicine, diabetes
posted by Anonymous at 6:00 AM
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