According to the American College of Physicians (ACP), what is the HbA1c target level in the management of type 2 diabetes mellitus (DM)?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

According to a 2018 guidance statement by the American College of Physicians (ACP), “Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.” The ACP said that this higher target is aimed at helping patients benefit from glycemic control while avoiding the adverse effects—associated with low blood sugar, medication burden, and costs—of stricter targets. The ACP stated that evidence does not indicate that medication therapy to reduce the HbA1c level to 7% or less results in reduced mortality or in decreased macrovascular complications, such as heart attack or stroke, compared with a reduction to about 8%. [129, 130]

However, experts from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) have expressed skepticism about the higher target, noting that the guidance statement does not take into account the cardiovascular disease benefits of newer drugs, which themselves frequently reduce HbA1c levels. In response, a coauthor of the ACP statement observed that other guidelines have also not specifically accounted for these newer medications in their recommended HbA1c levels and that research on such drugs has primarily been in patients either with cardiovascular disease or at high risk of developing it. [129]


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