The American College of Physicians (ACP) has issued new guidelines regarding the target blood sugar control levels for people with type 2 diabetes who are not pregnant, and the recommendations aim for a more moderate target.1
What is HbA1c?
The hemoglobin A1C (HbA1c) test is frequently used in people with type 2 diabetes as a measure of how their blood sugar is controlled. HbA1c averages a person’s blood sugar levels from the previous 2-3 months, and it is often used during initial diagnosis as well, with a score of 6.5% indicating diabetes. Traditionally, people with type 2 diabetes have been advised to keep their HbA1c levels below 7% (basically, at 6.5%). However, new research has prompted experts to issue new guidelines that the target HbA1c level for people with type 2 diabetes who are not pregnant should be between 7% and 8%.1,2
Risks and benefits of revised HbA1c guidelines
Originally, it was believed that keeping HbA1c levels below 7% would reduce the long-term risk of microvascular complications (those related to the smallest blood vessels), such as diabetic retinopathy (changes to eyesight or even blindness), kidney disease, and neuropathy (nerve damage that can cause numbness or pain).2,3 In creating the new guidelines, the ACP reviewed several research studies and found that for most people with type 2 diabetes, aiming for an HbA1c level between 7% and 8% best balances the long-term benefits with the potential risks of medications, including low blood sugar and health care costs.1,2
The latest research indicates that a slightly higher A1c level does not negatively impact patients and does not increase the risk of death, heart attacks, stroke, kidney failure, visual impairment, amputations, or neuropathy, according to Dr. Jack Ende, the president of the ACP. While medications that lower blood sugar can benefit many people with type 2 diabetes, all medications have the potential to cause side effects. The most common side effect from medications is that they may lower blood sugar too much, causing episodes of hypoglycemia.1,2
In addition, for people with type 2 diabetes who are 80 years or older, and those who have chronic conditions like dementia, cancer, chronic obstructive pulmonary disease (COPD), or congestive heart failure, the new guidelines recommend that treatment should focus on reducing their symptoms from high blood sugar rather than focusing on HbA1c levels. For these individuals, the risk of side effects from medications that lower blood sugar outweigh the advantages.1,2
Medications and lifestyle approaches
While the new guidelines focus on medication strategies to control blood sugar, Dr. Ende notes that for many people, a lower A1C target can be achieved through lifestyle modifications, including dietary changes, exercise, and weight loss.2
The guidelines also recommend that doctors should personalize blood sugar goals for each individual patient, taking into account the risks and benefits of potential medications, the patient’s preferences, their general health, the burden of treatment, and the costs of treatment.1
Sandoiu A. Type 2 diabetes: new guidelines lower blood sugar control levels. Medical News Today. Available at https://www.medicalnewstoday.com/articles/321123.php. Accessed 3/19/18.
Qaseem A, Wilt TJ, Kansagara D, et al. 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. [Epub ahead of print 6 March 2018] doi: 10.7326/M17-0939.
Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. 2008 Apr;26(2):77-82. doi: https://doi.org/10.2337/diaclin.26.2.77.