American Diabetes Association takes issue with ACP’s blood sugar targets

The American Diabetes Association (ADA) released a statement March 8 in response to the American College of Physicians’ (ACP) guidance statement on blood glucose targets, saying it is “deeply concerned” with the recommendations.

ACP president Jack Ende, MD, summarized that “most” patients with type 2 diabetes should be treated to a hemoglobin A1C target between 7 and 8 percent because it “will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs.”

But the ADA said a “reasonable A1C goal” is less than 7 percent for many nonpregnant adults based on evidence from four international clinical trials. There should be no lower limit on A1C targets as long as there is minimal risk of hypoglycemia, the ADA contends.

“The ADA believes all people diagnosed with type 2 diabetes can be healthy and should have the opportunity to reduce their risk of serious diabetes complications through appropriate blood glucose targets,” said William T. Cefalu, MD, the ADA’s chief scientific, medical and mission officer. “Individualization of targets is the key factor in designing the most appropriate regimen for patients with type 2 diabetes. However, by lumping ‘most’ people with type 2 diabetes into a 7 to 8 percent target range, ACP’s new guidance could cause increased complication rates for those who may safely benefit from lower evidence-based targets.”

The ADA said newer medications such as SGLT2 inhibitors and GLP-1 receptor agonists have a low risk of hypoglycemia and may help clinicians reach lower A1C targets without complications.

The organization also took issue with the ACP’s recommendation that clinicians seek to alleviate symptoms rather than hit specific A1C targets in patients with life expectancies of less than 10 years due to advanced age or chronic conditions. This may be appropriate in end-of-life cases, the ADA said, but not for all patients fitting these criteria.

“The ADA disagrees that this applies broadly to anyone over age 80, anyone living in a nursing home, or anyone with chronic conditions and who has a limited life expectancy,” the statement read. “Each specific case should be evaluated individually, as a person living in a nursing home or with a chronic condition may yet have some years to live and would likely prefer to live them without diabetes complications.”