Brief Commentary: Confusing Treatment Guidelines for Patients With Type 2 Diabetes
Authors: Irl B. Hirsch, Jay S. Skyler
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions21 August 2018Brief Commentary: Confusing Treatment Guidelines for Patients With Type 2 DiabetesIrl B. Hirsch, MD and Jay S. Skyler, MDIrl B. Hirsch, MDUniversity of Washington School of Medicine, Seattle, Washington (I.B.H.)Search for more papers by this author and Jay S. Skyler, MDUniversity of Miami School of Medicine, Miami, Florida (J.S.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1473 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.A recent guideline from the American College of Physicians (ACP) about glycemic control targets for adults with type 2 diabetes has sparked controversy (1). Four diabetes/endocrine societies immediately noted their concerns in a press statement (2), and the American Diabetes Association released a detailed critique and commentary (3, 4). Such public disagreements about guideline recommendations and treatment goals do not have a calming effect on patients. Patients wonder, as do we, how a fundamental ...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. Diabetes organizations strongly disagree with ACP's higher blood glucose targets for type 2 diabetes [press release]. Washington, DC: Endocrine Society; 9 March 2018. Accessed at www.endocrine.org/news-room/2018/diabetes-organizations-strongly-disagree-with-acps-higher-blood-glucose-targets-for-type-2-diabetes on 27 May 2018. Google Scholar3. American Diabetes Association deeply concerned about new guidance from American College of Physicians regarding blood glucose targets for people with type 2 diabetes [press release]. Arlington, VA: American Diabetes Association; 8 March 2018. Accessed at www.diabetes.org/newsroom/press-releases/2018/index.jsp?page=2 on 27 May 2018. Google Scholar4. Riddle MC, Gerstein HC, Holman RR, Inzucchi SE, Zinman B, Zoungas S, et al. A1C targets should be personalized to maximize benefits while limiting risks [Editorial]. Diabetes Care. 2018;41:1121-4. [PMID: 29784695] doi:10.2337/dci18-0018 CrossrefMedlineGoogle Scholar5. Draznin B, Nathan DM, Korytkowski MT, McDonnell ME, Golden SH, Schutta MH, et al. Guidelines versus guidelines: what's best for the patient? Ann Intern Med. 2018. [PMID: 29800101]. doi:10.7326/M18-0939 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Washington School of Medicine, Seattle, Washington (I.B.H.)University of Miami School of Medicine, Miami, Florida (J.S.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1473.Corresponding Author: Irl B. Hirsch, MD, 4225 Roosevelt Way NE, Seattle, WA 98105; e-mail, [email protected]edu.Current Author Addresses: Dr. Hirsch: 4225 Roosevelt Way NE, Seattle, WA 98105.Dr. Skyler: University of Miami School of Medicine, PO Box 016960 (D-110), Miami, FL 33101.Author Contributions: Conception and design: I.B. Hirsch, J.S. Skyler.Drafting of the article: I.B. Hirsch, J.S. Skyler.Critical revision of the article for important intellectual content: J.S. Skyler.Final approval of the article: I.B. Hirsch, J.S. Skyler.This article was published at Annals.org on 26 June 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBrief Commentary: Laboratory Accuracy of Hemoglobin A1c Ranges and Treatment Targets for Patients With Type 2 Diabetes Brian V. Burke and Sandra Hedin Brief Commentary: The Glycemic Target Guideline Controversy: Same Evidence, Different Perspectives, and a Proposal for Common Ground David C. Aron , Paul R. Conlin , and Leonard Pogach Brief Commentary: Social Determinants of Health and Treatment Targets for Type 2 Diabetes D.R. Bailey Miles Brief Commentary: Glycemic Targets for Older Adults With Type 2 Diabetes Emily B. Schroeder and Andrew J. Karter Metrics 21 August 2018Volume 169, Issue 4Page: 253KeywordsAcademic medicineCardiovascular therapyClinical trialsConflicts of interestDisclosureHemoglobinHypoglycemiaPatientsTreatment guidelinesType 2 diabetes ePublished: 26 June 2018 Issue Published: 21 August 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...