Hemoglobin A<sub>1c</sub> Targets for Glycemic Control With Pharmacologic Therapy
Authors: Timothy J. Wilt, Michael J. Barry, Devan Kansagara, Amir Qaseem
Journal: Annals of Internal Medicine (2018)

Letters2 October 2018Hemoglobin A1c Targets for Glycemic Control With Pharmacologic TherapyTimothy J. Wilt, MD, MPH, Michael J. Barry, MD, Devan Kansagara, MD, MCR, and Amir Qaseem, MD, PhD, MHATimothy J. Wilt, MD, MPHMinneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.)Search for more papers by this author, Michael J. Barry, MDMassachusetts General Hospital, Boston, Massachusetts (M.J.B.)Search for more papers by this author, Devan Kansagara, MD, MCROregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon (D.K.)Search for more papers by this author, and Amir Qaseem, MD, PhD, MHAAmerican College of Physicians, Philadelphia, Pennsylvania (A.Q.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0373 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Drs. O'Keeffe and Maraka and Drs. Dutta and Mukhopadhyay that balancing benefits, harms, cost, and patient-centeredness is important to achieve appropriate HbA1c levels in individual patients. Our guidance statement emphasizes a personalized approach to HbA1c targets (1). Although patients with long life expectancies are at greater risk for diabetes complications, intensive pharmacologic treatment targets would also require decades to yield benefits. The lifetime balance of benefits with harms, costs, and the burden of pharmacologic treatment targets to an HbA1c level less than 6.5% in young persons with newly diagnosed diabetes is unknown, and research is ...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. Palmer SC, Mavridis D, Nicolucci A, Johnson DW, Tonelli M, Craig JC, et al. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: a meta-analysis. JAMA. 2016;316:313-24. [PMID: 27434443] doi:10.1001/jama.2016.9400 CrossrefMedlineGoogle Scholar3. Zheng SL, Roddick AJ, Aghar-Jaffar R, Shun-Shin MJ, Francis D, Oliver N, et al. Association between use of sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase 4 inhibitors with all-cause mortality in patients with type 2 diabetes: a systematic review and meta-analysis. JAMA. 2018;319:1580-91. [PMID: 29677303] doi:10.1001/jama.2018.3024 CrossrefMedlineGoogle Scholar4. Chew EY, Ambrosius WT, Davis MD, Danis RP, Gangaputra S, Greven CM, et al; ACCORD Study Group. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. 2010;363:233-44. [PMID: 20587587] doi:10.1056/NEJMoa1001288 CrossrefMedlineGoogle Scholar5. Ismail-Beigi F, Craven T, Banerji MA, Basile J, Calles J, Cohen RM, et al; ACCORD trial group. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010;376:419-30. [PMID: 20594588] doi:10.1016/S0140-6736(10)60576-4 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.)Massachusetts General Hospital, Boston, Massachusetts (M.J.B.)Oregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon (D.K.)American College of Physicians, Philadelphia, Pennsylvania (A.Q.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0939. 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 Derek T. O'Keeffe and Spyridoula Maraka Metrics Cited byTreat to target in axial spondyloarthritis: From its concept to its implementation 2 October 2018Volume 169, Issue 7Page: 513KeywordsClinical trialsDisclosureDrug therapyDrugsHbA1cLife expectancyMortalityPregnancyRetinopathyVision ePublished: 2 October 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...