The American College of Physicians (ACP) has published new care guidelines suggesting higher blood sugar targets for people with type 2 diabetes. But many fear they may be doing harm than good with this change, that could potentially lead to patients developing more long-term complications and PWDs (people with diabetes) facing increased barriers to accessing to the supplies and medications we need. Not good.

American College of Physician's logoPublished March 6 in the , these new guidelines call for A1C targets of 7-8% for most T2 PWDs, noting that lower A1C goals of 6.5% to 7% as recommended by the big diabetes orgs are too strict.

While the new guidelines do recommend "personalization of glycemic goals" depending on patients' individual circumstances, they clearly call for  "deintensifying" therapy across the board. The ACP cites studies showing evidence that encouraging T2s to check blood sugar more often and take more medications has not been beneficial.

"The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7-8% will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs,” ACP President Dr. Jack Ende said in a .

Not everyone agrees. In fact, this is causing a firestorm among the diabetes authorities, who worry that these new guidelines, while specific to T2, could have negative implications for all PWDs: downgrading care and providing a basis for insurers to further restrict access to testing supplies, needed medicines and of course CGMs (continuous glucose monitors).

 

Diabetes Authorities Disagree

The ACP guidelines are aimed at primary care physicians, who remain the main source of care for millions of T2Ds in this country. As guidelines, these recommendations are not binding. But the key diabetes orgs representing endocrinologists and specialists are clearly worried about the message this sends.

The American Diabetes Association (ADA), American Association of Diabetes Educators (AADE), American Association of Clinical Endos (AACE) and Endocrine Society have in opposition. Their main concern: This could prevent many T2Ds from receiving the full benefits of long-term glucose control.

"We are also concerned the broad range suggested by ACP’s guidance is too large to apply to 'most patients with type 2 diabetes' and has the potential to do more harm than good for many patients for whom lower blood glucose targets may be more appropriate," the joint statement says, referring to an increased risk of complications such as cardiovascular disease, retinopathy, amputations and kidney disease.

On top of that, the D-orgs point out the ACP guidelines do not account for more modern diabetes medications such as that have been shown to benefit the T2 community and reduce complications while also leading to better BG management.

"These changes should in no way be interpreted as diabetes is unimportant," ACP's Ende countered when queried by . "A1C targets are being used now as a performance measure... (and that's) not always consistent with the best possible evidence."

He cites the example of an 80-year-old patient with memory problems versus a fit 50-year-old: it may not be safe for them to pursue the same A1C target, "as diabetes therapies can cause low blood sugar levels, which can also cause health problems."

 

Confusion and Worry

Many PWDs are worried about these conflicting recommendations, and what effects they may have.

Clearly, the last thing we need in this day and age of impaired access and affordability is even more fodder that could be used to deny insurance claims for diabetes meds and supplies. And will the new guidelines fuel pushback or laziness, as in the much-dreaded "treat to fail" mentality in the medical profession?

Wil Dubois

Our own 'Mine columnist Wil Dubois, a T1D with over a decade of clinical educator experience, says: "I don't know who to believe... There are compelling arguments on both sides, which are simply different interpretations of the same evidence. I'm not smart enough to know who is right, maybe no one is -- or we wouldn't have these competing guidelines -- but my gut says lower is better. We know that sugar-normals don't get complications. We know PWDs do. Therefore, the closer we can get to 'normal,' the less risk there is."

Wil adds that only one thing is for certain: No good can come from the confusion.

"I worry that physicians who choose to hold the line will have even greater challenges getting medications covered as insurance companies are sure to adopt the new higher sugar targets, as it will be more economical for them -- at least until we get complications."

Heated discussion has erupted around the Diabetes Online Size now (DOC) as well:

 

We can only hope that common sense prevails, and both providers and insurers remember a key truth: We aren't textbook cases but individual people faced with this life-threatening illness, and we deserve access to the best possible treatment options to keep our diabetes in check.

 

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