Hemoglobin A<sub>1c</sub> Targets for Glycemic Control With Pharmacologic Therapy
Authors: Joel Zonszein, Michael Brownlee
Journal: Annals of Internal Medicine (2018)

Letters2 October 2018Hemoglobin A1c Targets for Glycemic Control With Pharmacologic TherapyJoel Zonszein, MD, CDE and Michael Brownlee, MDJoel Zonszein, MD, CDEMontefiore Medical Center and Albert Einstein College of Medicine, New York, New York (J.Z., M.B.)Search for more papers by this author and Michael Brownlee, MDMontefiore Medical Center and Albert Einstein College of Medicine, New York, New York (J.Z., M.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0372 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Several recommendations from the ACP guidance statement (1) are scientifically inaccurate and clinically misleading. We agree that the goals should be for clinicians to individualize treatment for certain patients with type 2 diabetes and aim to minimize hypoglycemia. However, the recommendation to change HbA1c targets from less than 7% to between 7% and 8% is based on seriously flawed analyses of the available data. It relies excessively on the analysis of the original ACCORD trial. It also was based on analyses from the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron–MR Controlled Evaluation) trial, VADT, ...References1. Qaseem A, Wilt TJ, Kansagara D, Horwitch C, Barry MJ, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. 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;168:569-76. [PMID: 29507945]. doi:10.7326/M17-0939 LinkGoogle Scholar2. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577-89. [PMID: 18784090] doi:10.1056/NEJMoa0806470 CrossrefMedlineGoogle Scholar3. Riddle MC, Ambrosius WT, Brillon DJ, Buse JB, Byington RP, Cohen RM, et al; Action to Control Cardiovascular Risk in Diabetes Investigators. Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial. Diabetes Care. 2010;33:983-90. [PMID: 20427682] doi:10.2337/dc09-1278 CrossrefMedlineGoogle Scholar4. Cefalu WT, Kaul S, Gerstein HC, Holman RR, Zinman B, Skyler JS, et al. Cardiovascular outcomes trials in type 2 diabetes: where do we go from here? Reflections from a diabetes care editors' expert forum. Diabetes Care. 2018;41:14-31. [PMID: 29263194] doi:10.2337/dci17-0057 CrossrefMedlineGoogle Scholar5. Ali MK, Bullard KM, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010 [Letter]. N Engl J Med. 2013;369:287-8. [PMID: 23863067] doi:10.1056/NEJMc1306652 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Montefiore Medical Center and Albert Einstein College of Medicine, New York, New York (J.Z., M.B.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0372. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHemoglobin 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 Amir Qaseem , Timothy J. Wilt , Devan Kansagara , Carrie Horwitch , Michael J. Barry , Mary Ann Forciea , and Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy Timothy J. Wilt , Michael J. Barry , Devan Kansagara , and Amir Qaseem Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy Deep Dutta and Satinath Mukhopadhyay Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy David Walton Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy Derek T. O'Keeffe and Spyridoula Maraka Metrics Cited byIn type 2 diabetes, intensive glucose control for 5.6 years did not differ from usual care for major CV events at 14 yearsGaetano Santulli, MD 2 October 2018Volume 169, Issue 7Page: 512-513KeywordsDisclosureHbA1cHypoglycemiaMortalityPopulation statisticsProspective studiesProtease inhibitorsRetinopathyType 2 diabetesVascular diseases ePublished: 2 October 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...