War Erupts Over HbA1c Goals -- Who's Right?

The latest statement by the ACP (American college of Physicians) reports that HbA1c, a marker for diabetic control, be between 7-8. Anything lower might cause hypoglycemia. Furthermore overall mortality is not affected by more stringent control.

This is clearly a contradistinction to what the ADA (American Diabetic Association) believes. I concur with the ADA that a level of 8 is NOT good enough.

First of all death is not the only end point. There are reports that many of the microvascular complications of diabetes can be mitigated by tighter glycemic control. Examples include retinopathy, kidney disease and neuropathy.

A major concern by the ACP was the risk of hypoglycemia (or low blood sugar) by tight control of diabetes. What they failed to mention is that many of the newer agents used in diabetes do not significantly lower blood sugar levels. Why I don't even use these older drugs that are infamous for lowering blood sugar.

Keep in mind that this was based on diabetics on medications. In my practice, I always start with lifestyle,My aim is to convert a diabetic to a borderline, and a borderline to a non-diabetic status. Getting the A1c below 7 and preferably below 6.5 is my aim.

Read original article here: https://www.medpagetoday.com/endocrinology/diabetes/72336