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in a statement released Friday, March 9.
The new guideline, which was published in the Annals of Internal Medicine on March 5 “could prevent many patients from receiving the full benefits of long-term glucose control,” according to a joint statement from the Endocrine Society, American Diabetes Association, American Association of Diabetes Educators, and American Association of Clinical Endocrinologists.
“The main concern here is this statement is too large to apply to most people with type 2 diabetes,” Grazia Aleppo, MD, chair of the Endocrine Society’s Clinical Affairs Core Committee, said in an interview. “We are all in agreement among the societies to include the ACP’s recommendation on individualizing treatment, but there is a big difference in a 1% HbA1c increase.
“A 7% HbA1c reflects the average of about 154 mg/dL on average, but 8% reflects the average of about 183 mg/dL.”
With patients without diabetes averaging between 70 and 99 mg/dL, a jump to 183 is concerning for Dr. Aleppo and her colleagues.
The ACP’s recommendations were determined from analysis of four drug therapy trials, which found aiming HbA1c levels at below 7% put patients at risk for hypoglycemia and cardiovascular events.
While the trials themselves were approved by the ADA, AADE, and AACE, associations expressed concern with the exclusion of important data, including the addition of newly diagnosed patients in the test population and more modern medications that reduce the adverse effects mentioned in the ACP’s reasoning for raising the target levels.
The patients participating in the trials were older and could have already had underlying cardiovascular disease, according to Dr. Aleppo. These factors plus a rapid change to their medication to get them below 6.5% could have instigated a cardiovascular response, which would not be as likely for patients in their 40s who are just being diagnosed.
“A great majority of patients who are seen in the primary care setting usually don’t have advanced diabetes and, in that case, if someone does not have an increased risk for hypoglycemia, which is the concern that the ACP has, they should be kept at the tightest possible control so that when they are much older they have a legacy effect of good control of their disease,” said Dr. Aleppo.** “Also, if you place someone on modern, lower-risk medications that are so much safer today than before, these actually have been shown not only to improve glucose level in high-risk patients, they can actually cause a very big improvement in cardiovascular disease outcomes.”
Sodium-glucose cotransporter 2 inhibitors and glucagonlike peptide-1 receptor agonists are both newer medications with signs of high success, according to Dr. Aleppo.*
At press time the American College of Physicians was unable to provide a statement.
ezimmerman@frontlinemedcom.com
Corrections, 3/12/18: *An earlier version of this article misstated one of the drug classes mentioned.
**An earlier version of this article misstated a reference to the patient group specified.
in a statement released Friday, March 9.
The new guideline, which was published in the Annals of Internal Medicine on March 5 “could prevent many patients from receiving the full benefits of long-term glucose control,” according to a joint statement from the Endocrine Society, American Diabetes Association, American Association of Diabetes Educators, and American Association of Clinical Endocrinologists.
“The main concern here is this statement is too large to apply to most people with type 2 diabetes,” Grazia Aleppo, MD, chair of the Endocrine Society’s Clinical Affairs Core Committee, said in an interview. “We are all in agreement among the societies to include the ACP’s recommendation on individualizing treatment, but there is a big difference in a 1% HbA1c increase.
“A 7% HbA1c reflects the average of about 154 mg/dL on average, but 8% reflects the average of about 183 mg/dL.”
With patients without diabetes averaging between 70 and 99 mg/dL, a jump to 183 is concerning for Dr. Aleppo and her colleagues.
The ACP’s recommendations were determined from analysis of four drug therapy trials, which found aiming HbA1c levels at below 7% put patients at risk for hypoglycemia and cardiovascular events.
While the trials themselves were approved by the ADA, AADE, and AACE, associations expressed concern with the exclusion of important data, including the addition of newly diagnosed patients in the test population and more modern medications that reduce the adverse effects mentioned in the ACP’s reasoning for raising the target levels.
The patients participating in the trials were older and could have already had underlying cardiovascular disease, according to Dr. Aleppo. These factors plus a rapid change to their medication to get them below 6.5% could have instigated a cardiovascular response, which would not be as likely for patients in their 40s who are just being diagnosed.
“A great majority of patients who are seen in the primary care setting usually don’t have advanced diabetes and, in that case, if someone does not have an increased risk for hypoglycemia, which is the concern that the ACP has, they should be kept at the tightest possible control so that when they are much older they have a legacy effect of good control of their disease,” said Dr. Aleppo.** “Also, if you place someone on modern, lower-risk medications that are so much safer today than before, these actually have been shown not only to improve glucose level in high-risk patients, they can actually cause a very big improvement in cardiovascular disease outcomes.”
Sodium-glucose cotransporter 2 inhibitors and glucagonlike peptide-1 receptor agonists are both newer medications with signs of high success, according to Dr. Aleppo.*
At press time the American College of Physicians was unable to provide a statement.
ezimmerman@frontlinemedcom.com
Corrections, 3/12/18: *An earlier version of this article misstated one of the drug classes mentioned.
**An earlier version of this article misstated a reference to the patient group specified.
in a statement released Friday, March 9.
The new guideline, which was published in the Annals of Internal Medicine on March 5 “could prevent many patients from receiving the full benefits of long-term glucose control,” according to a joint statement from the Endocrine Society, American Diabetes Association, American Association of Diabetes Educators, and American Association of Clinical Endocrinologists.
“The main concern here is this statement is too large to apply to most people with type 2 diabetes,” Grazia Aleppo, MD, chair of the Endocrine Society’s Clinical Affairs Core Committee, said in an interview. “We are all in agreement among the societies to include the ACP’s recommendation on individualizing treatment, but there is a big difference in a 1% HbA1c increase.
“A 7% HbA1c reflects the average of about 154 mg/dL on average, but 8% reflects the average of about 183 mg/dL.”
With patients without diabetes averaging between 70 and 99 mg/dL, a jump to 183 is concerning for Dr. Aleppo and her colleagues.
The ACP’s recommendations were determined from analysis of four drug therapy trials, which found aiming HbA1c levels at below 7% put patients at risk for hypoglycemia and cardiovascular events.
While the trials themselves were approved by the ADA, AADE, and AACE, associations expressed concern with the exclusion of important data, including the addition of newly diagnosed patients in the test population and more modern medications that reduce the adverse effects mentioned in the ACP’s reasoning for raising the target levels.
The patients participating in the trials were older and could have already had underlying cardiovascular disease, according to Dr. Aleppo. These factors plus a rapid change to their medication to get them below 6.5% could have instigated a cardiovascular response, which would not be as likely for patients in their 40s who are just being diagnosed.
“A great majority of patients who are seen in the primary care setting usually don’t have advanced diabetes and, in that case, if someone does not have an increased risk for hypoglycemia, which is the concern that the ACP has, they should be kept at the tightest possible control so that when they are much older they have a legacy effect of good control of their disease,” said Dr. Aleppo.** “Also, if you place someone on modern, lower-risk medications that are so much safer today than before, these actually have been shown not only to improve glucose level in high-risk patients, they can actually cause a very big improvement in cardiovascular disease outcomes.”
Sodium-glucose cotransporter 2 inhibitors and glucagonlike peptide-1 receptor agonists are both newer medications with signs of high success, according to Dr. Aleppo.*
At press time the American College of Physicians was unable to provide a statement.
ezimmerman@frontlinemedcom.com
Corrections, 3/12/18: *An earlier version of this article misstated one of the drug classes mentioned.
**An earlier version of this article misstated a reference to the patient group specified.