Type 2 diabetes: Latest recommendations minimize the level of control in blood sugar

The American College of Physicians has now released its new recommendations for people with type 2 diabetes about the optimal blood sugar regulation levels. The goal of the guidelines is to improve current therapeutic practices and doctors should aim for a moderate blood sugar level while their patients are being treated.

Blood sugar control
Blood sugar control levels should be moderate for people living with type 2 diabetes, according to new guidelines.

Nearly 30 million individuals in the United States have type 2 diabetes, which amounts to over 9 percent of the entire U.S. population, according to the most recent figures.

In order to keep blood sugar levels under control, patients are often advised to take what is known as a glycated hemoglobin (HbA1c) test when diagnosed with type 2 diabetes.

The test measures the blood sugar levels of a person over the past 2 or 3 months, with a 6.5 percent HbA1c score indicating diabetes.

A daily insulin based treatment that they can inject themselves would then be prescribed to patients who score over 6.5 percent. Injections of rapid action take effect within 5 to 15 minutes, but last 3 to 5 hours for a shorter period of time. After 1 or 2 hours, long-acting injections take effect and last for between 14 and 24 hours.

But some studies have pointed out that in the U.S., the HbA1c test may currently be overused, and they have suggested that such over-testing may lead to hypoglycemic drug over-treatment in patients.

These drugs often have a variety of side effects, including gastrointestinal problems, excessively low blood sugar, weight gain, and even heart failure with congestion.

In addition, as some researchers have pointed out, “Excessive testing leads to the growing problem of healthcare waste and increased patient burden in the management of diabetes.”

In this context, in an effort to help doctors make better , more informed decisions about treating people with type 2 diabetes, the American College of Physicians (ACP) set out to examine the existing guidelines from several organizations and the evidence available.

Their guidelines have been published in the Annals of Internal Medicine journal.

An A1C of 7 to 8 percent is recommended

The current rationale behind the current recommendations of a score of 6.5 percent or below 7 percent, as the ACP explains, is that maintaining this low blood sugar would reduce the risk over time of microvascular complications. The ACP found, however, that the evidence for such a decrease is “inconsistent.”

As Dr. Jack Ende, ACP President, puts it, “[Our] analysis of the evidence behind current guidelines found that drug treatment at targets of 7% or less compared to targets of about 8% did not reduce deaths or macrovascular complications such as heart attack or stroke, but resulted in significant harm.”

He continues, saying, ‘The evidence shows that achieving an A1C between 7 percent and 8 percent will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs for most people with type 2 diabetes.’

In addition, the ACP recommends that patients who are 80 years of age and older, or who are living with chronic diseases such as dementia, cancer, or congestive heart failure, receive treatment that focuses on reducing symptoms associated with high blood sugar instead of reducing levels of HbA1c.

The reason for this is that the potential side effects of hypoglycemic drugs outweigh the advantages for patients in this category.

“Results from studies included in all the guidelines show that treating A1C levels below 6.5 percent does not improve health outcomes,” Dr. Ende explains.

“However, reducing drug interventions persistently below 6.5 percent for patients with A1C levels will reduce unnecessary medication harms, burdens and costs without adversely affecting the risk of death, heart attacks, strokes, kidney failure, amputations, visual impairment, or painful neuropathy,” he continues.

“Although ACP’s guidance statement focuses on drug therapy to control blood sugar, a lower treatment target is appropriate if it can be achieved with diet and lifestyle modifications such as exercise, dietary changes, and weight loss.”

Dr. Jack Ende

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