Hemoglobin A<sub>1c</sub> Targets for Glycemic Control With Pharmacologic Therapy
Authors: Deep Dutta, Satinath Mukhopadhyay
Journal: Annals of Internal Medicine (2018)

Letters2 October 2018Hemoglobin A1c Targets for Glycemic Control With Pharmacologic TherapyDeep Dutta, MD, DM and Satinath Mukhopadhyay, MD, DMDeep Dutta, MD, DMVenkateshwar Hospitals, New Delhi, India (D.D.)Search for more papers by this author and Satinath Mukhopadhyay, MD, DMInstitute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India (S.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0370 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read the ACP guidance statement (1) suggesting a more lenient glycemic target between 7% and 8% in patients with diabetes. The authors are partially correct in highlighting the lack of strong scientific data supporting the hypothesis that achieving HbA1c targets less than 6.5% instead of between 7% and 8% significantly decreases micro- and macrovascular complications. A more stringent HbA1c target is associated with higher risks for hypoglycemia and cardiovascular events and has been documented in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial and VADT (Veterans Affairs Diabetes Trial). However, patients in these trials ...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. Dutta D, Mukhopadhyay S. Intervening at prediabetes stage is critical to controlling the diabetes epidemic among Asian Indians. Indian J Med Res. 2016;143:401-4. [PMID: 27377494] doi:10.4103/0971-5916.184281 CrossrefMedlineGoogle Scholar3. Dutta D, Choudhuri S, Mondal SA, Mukherjee S, Chowdhury S. Urinary albumin–creatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: role of associated insulin resistance, inflammatory cytokines and low vitamin D. J Diabetes. 2014;6:316-22. [PMID: 24251376] doi:10.1111/1753-0407.12112 CrossrefMedlineGoogle Scholar4. Sörensen BM, Houben AJ, Berendschot TT, Schouten JS, Kroon AA, van der Kallen CJ, et al. Prediabetes and type 2 diabetes are associated with generalized microvascular dysfunction: the Maastricht study. Circulation. 2016;134:1339-52. [PMID: 27678264] CrossrefMedlineGoogle Scholar5. Wilson ML. Prediabetes: beyond the borderline. Nurs Clin North Am. 2017;52:665-77. [PMID: 29080583] doi:10.1016/j.cnur.2017.07.011 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Venkateshwar Hospitals, New Delhi, India (D.D.)Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India (S.M.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0370. 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 David Walton Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy Joel Zonszein and Michael Brownlee 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 Derek T. O'Keeffe and Spyridoula Maraka Metrics 2 October 2018Volume 169, Issue 7Page: 511-512KeywordsConflicts of interestDisclosureDrug therapyHbA1cHemoglobinHypoglycemiaPhenotypesPregnancyType 2 diabetes ePublished: 2 October 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...