Hemoglobin A<sub>1c</sub> Targets for Glycemic Control With Pharmacologic Therapy
Authors: Derek T. O'Keeffe, Spyridoula Maraka
Journal: Annals of Internal Medicine (2018)

Letters2 October 2018Hemoglobin A1c Targets for Glycemic Control With Pharmacologic TherapyDerek T. O'Keeffe, MB, BCh, BAO, PhD and Spyridoula Maraka, MD, MScDerek T. O'Keeffe, MB, BCh, BAO, PhDNational University of Ireland Galway, Galway, Ireland (D.T.O.)Search for more papers by this author and Spyridoula Maraka, MD, MScUniversity of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas (S.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0369 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The American College of Physicians (ACP) guidance statement (1) examined the evidence behind other organizations' recommendations for diabetes (2–5). The authors concluded that drug treatment to a hemoglobin A1c (HbA1c) level less than 8% produced the same clinically significant end points (for example, heart attack and vision impairment) as treatment to a level less than 7% but with a reduced risk for hypoglycemic harm, a lower medication burden, and a decrease in associated costs.This finding highlights a more complex issue in medicine: how a disease is defined and treated. Physiology has taught us about the exquisite ...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. American Diabetes Association. 6. Glycemic targets. Diabetes Care. 2017;40:S48-56. [PMID: 27979893] CrossrefMedlineGoogle Scholar3. Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017;23:1-87. [PMID: 28437620] doi:10.4158/EP171764.APPGL CrossrefMedlineGoogle Scholar4. Scottish Intercollegiate Guidelines Network. Management of Diabetes: A National Clinical Guideline. Publication no. 116. Edinburgh, Scotland: Scottish Intercollegiate Guidelines Network; 2013. Google Scholar5. Department of Veterans Affairs; Department of Defense. VA/DoD clinical practice guideline for the management of type 2 diabetes mellitus in primary care. (Prepared by the Management of Type 2 Diabetes Mellitus in Primary Care Work Group.) Version 5.0. April 2017. Accessed at www.healthquality.va.gov/guidelines/CD/diabetes/VADoDDMCPGFinal508.pdf on 24 August 2018. Google Scholar Author, Article, and Disclosure InformationAffiliations: National University of Ireland Galway, Galway, Ireland (D.T.O.)University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas (S.M.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0369. 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 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 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 Metrics 2 October 2018Volume 169, Issue 7Page: 510-511KeywordsDisclosureHbA1cHemoglobinHypoglycemiaHypoglycemicsMyocardial infarctionPathology and laboratory medicineSodiumTreatment guidelinesVision ePublished: 2 October 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...