New Diabetes Guidelines Create a Stir

By:

Garrett Schaffel,

The American College of Physicians (ACP) on Tuesday published new recommendations for blood sugar management in those with type 2 diabetes. The guidelines call for relaxing target glucose

levels and differ from those established by the American Diabetes Association (ADA) and other medical organizations. As a result, the news ignited plenty of back-and-forth on the subject.

The standard recommendation has been to shoot for an A1C — a blood test measuring blood sugar levels – of less than 7 percent. This recommendation is supported by many medical associations,

including the ADA and the American Association of Clinical Endocrinologists (AACE). Above 7 percent, their experts say, patients have undue risk of life-threatening health problems

associated with high blood sugar. 

One of those problems, of course, is diabetes, the seventh leading cause of death in the United States.

But the ACP’s new target, published in the Annals of Internal Medicine, is for between 7 and 8 percent. Why is it controversial? The ACP recommendation is higher than the standard

recommendation for diabetic patients and, according to a recent ADA press release, "has the potential to do more harm than good for many patients for whom lower blood glucose targets may be

more appropriate." For people ages 80 and older and those with chronic medical issues, however, the recommendation would not apply.  

The ADA publicly rejected the ACP’s guidance, as did the AACE.

“It’s been clear over the years that decreasing the A1C decreases common diabetes complications, including kidney, eye and nerve complications,” says AACE President Jonathan Leffert, M.D.

A lower diabetes risk, he says, also decreases the risk of heart problems, which "is very important because diabetes patients are two- to fourfold more likely to develop heart issues.”

But in releasing its lower A1C guidelines, the ACP stressed how a too-low glucose level can lead to health problems. “There are harms associated with overzealous treatment or inappropriate

treatment focused on A1C targets,” Jack Ende, M.D., president of the ACP, told NPR. Symptoms of hypoglycemia (low blood sugar) include lightheadedness, fatigue and fainting.

But Leffert argues that “