Dealing with diabetes often means dealing with numbers — blood glucose, weight, BMI (body-mass index), medication dosage. And the important number known as A1C. An A1C test measures a person’s blood sugar control over the preceding 2–3 months, and a number 6.5 percent or above is usually considered an indication of diabetes.
Recently, the American College of Physicians (ACP), the largest medical specialty organization in the United States, made news when it proposed changing the recommended A1C target guidelines. It said that people with Type 2 diabetes should aim to achieve an A1C between 7 and 8 percent instead of 6.5 to 7 percent, as previously advised. According to Jack Ende, MD president of the ACP, an analysis of the evidence determined that using medications to lower A1C below 7 percent “did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms.”
The ACP statement pointed out that if health outcomes are not improved by using drugs to lower A1C below 6.5, then, as Dr. Ende put it, decreasing drug interventions “will reduce unnecessary medication harms, burdens and costs without negatively impacting the risk of death, heart attacks, strokes, kidney failure, amputations, visual impairment, or painful neuropathy.” He added that if A1C can be lowered without drugs through exercise, diet, and weight loss, then a goal below 6.5 is appropriate. The APC statement also recommended that physicians “personalize” treatment plans for their diabetes patients based on the patient’s preferences, general health, life expectancy, and other considerations.
The new APC guidelines were not received without some controversy, as some physicians questioned their advisability. The American Diabetes Association, for example, issued a statement stating that it was sticking to the old standard, saying that a “reasonable A1C goal for many nonpregnant adults with Type 2 diabetes is less than 7 percent.”
Want to learn more about the new A1C recommendations? See “Doctor’s Group Issues Controversial Type 2 Diabetes Guidelines: What You Need to Know,” then read “H-B-A-1-C: What It Is and Why It Matters” to learn more about the A1C test.