Brief Commentary: The Glycemic Target Guideline Controversy: Same Evidence, Different Perspectives, and a Proposal for Common Ground
Authors: David C. Aron, Paul R. Conlin, Leonard Pogach
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions21 August 2018Brief Commentary: The Glycemic Target Guideline Controversy: Same Evidence, Different Perspectives, and a Proposal for Common GroundDavid C. Aron, MD, MS, Paul R. Conlin, MD, and Leonard Pogach, MD, MBADavid C. Aron, MD, MSLouis Stokes Cleveland VA Medical Center, Cleveland, Ohio (D.C.A.)Search for more papers by this author, Paul R. Conlin, MDVA Boston Healthcare System, West Roxbury, Massachusetts (P.R.C.)Search for more papers by this author, and Leonard Pogach, MD, MBAVeterans Affairs Central Office, Washington, DC (L.P.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1342 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editors' Note: This commentary was selected for publication from among several submitted in response to a call for readers' perspectives on treatment targets for type 2 diabetes.The 2007 American College of Physicians guidance statement for type 2 diabetes recommended that “[t]reatment goals should be based on a discussion of the benefits and harms of specific levels of glycemic control with the patient. A hemoglobin A1c level less than 7% based on individualized assessment is a reasonable goal for many but not all patients” (1). At that time, recommended general target levels for hemoglobin A1c ranged from less than 6.5% (American ...References1. Qaseem A, Vijan S, Snow V, Cross JT, Weiss KB, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Glycemic control and type 2 diabetes mellitus: the optimal hemoglobin A1c targets. A guidance statement from the American College of Physicians. Ann Intern Med. 2007;147:417-22. [PMID: 17876024] LinkGoogle Scholar2. 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 Scholar3. Harris R. Major medical associations feud over diabetes guidelines. National Public Radio. 5 March 2018. Accessed at www.npr.org/sections/health-shots/2018/03/05/590922698/major-medical-associations-feud-over-diabetes-guidelines on 16 May 2018. Google Scholar4. Conlin PR, Colburn J, Aron D, Pries RM, Tschanz MP, Pogach L. Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline: management of type 2 diabetes mellitus. Ann Intern Med. 2017;167:655-63. [PMID: 29059687]. doi:10.7326/M17-1362 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio (D.C.A.)VA Boston Healthcare System, West Roxbury, Massachusetts (P.R.C.)Veterans Affairs Central Office, Washington, DC (L.P.)Disclaimer: The views expressed here are not to be construed as those of the U.S. Department of Veterans Affairs or the U.S. Department of Defense.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1342.Corresponding Author: Leonard Pogach, MD, MBA, Veterans Affairs Central Office, Office of Specialty Care (P11), 810 Vermont Avenue, Washington, DC 20420; e-mail, Leonard.[email protected]gov.Current Author Addresses: Dr. Aron: Director, Clinical Program Research and Evaluation, Louis Stokes Cleveland VA Medical Center Administrative, Building EUL 5M677, 10701 East Boulevard, Cleveland, OH 44106.Dr. Conlin: Chief, Medical Service, VA Boston Healthcare System, 1400 Veterans of Foreign Wars Parkway, West Roxbury, MA 02132.Dr. Pogach: Veterans Affairs Central Office, Office of Specialty Care (P11), 810 Vermont Avenue, Washington, DC 20420.Author Contributions: Conception and design: L. Pogach.Drafting of the article: L. Pogach.Critical revision of the article for important intellectual content: P.R. Conlin, L. Pogach.Final approval of the article: D.C. Aron, P.R. Conlin, L. Pogach.This article was published at Annals.org on 26 June 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBrief Commentary: Glycemic Targets for Older Adults With Type 2 Diabetes Emily B. Schroeder and Andrew J. Karter Brief Commentary: Social Determinants of Health and Treatment Targets for Type 2 Diabetes D.R. Bailey Miles Brief Commentary: Confusing Treatment Guidelines for Patients With Type 2 Diabetes Irl B. Hirsch and Jay S. Skyler Brief Commentary: Laboratory Accuracy of Hemoglobin A1c Ranges and Treatment Targets for Patients With Type 2 Diabetes Brian V. Burke and Sandra Hedin Metrics Cited byGravicentric approach to Type 2 Diabetes therapy. The success prediction. A proof-of-conceptPrecision Medicine and Complexity 21 August 2018Volume 169, Issue 4Page: 248-249KeywordsDisclosureHealth care providersHemoglobinLiteracyMedical servicesNumeracyPerformance measuresTreatment guidelinesType 2 diabetesVeteran care ePublished: 26 June 2018 Issue Published: 21 August 2018 PDF downloadLoading ...