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US doctors urged to increase HbA1c targets for adults with type 2 diabetes- is it??

naithru

Active member
A US organisation has recommended that HbA1c targets for adults with type 2 diabetes should be higher than suggested by existing guidelines.

The American College of Physicians (ACP) has informed doctors to advise people to aim for HbA1c levels between 7-8% (53-64 mmol/mol), rather than the traditional advice of 6.5-7% (48-53 mmol/mol).

The controversial advice has been met with scepticism by US physicians who believe the recommendations send "mixed messages" to people with type 2 diabetes.

Dr. Ajay Rao, from the Lewis Katz School of Medicine at Temple University, told Reuters Health the recommended range "is inconsistent with guidelines from most national and international organizations".

Dr Rao added that relaxing HbA1c goals "sends a mixed message to our patients, and potentially sends us backward in the fight against small vessel complications in type 2 diabetes."

The ACAP recommendation follows a review of six sets of guidelines from other organisations. Other recommendations include personalising blood sugar goals in patients on the basis of discussing treatment options; considering reduced drug therapy in patients with HbA1c below 6.5%; and minimising symptoms of high blood sugar.
 

renuka

Well-known member
As a doc I surely follow the 6.5-7% (48-53 mmol/mol) still till proven otherwise.

But on a personal observation I can safely say that there is no one size fit all for all human beings.

Some patients show no complications of any sort even though the Hb A1c is way off the mark and some have perfect control yet land up with complications.


Its as if each human has their own range of control which will be next to impossible to create a customized personal range.

For eg..my fathers HbA1c is 7-8% (53-64 mmol/mol), ...some docs suggested he start treatment and when he was put on treatment his blood sugar levels plunge too low.

He cant be on meds yet his body shows no signs and symptoms of diabetes and no end organ or small vessel complication at all!

Its as if his body functions perfectly fine with higher than the " normal" levels of blood sugar level.

What I am saying is not medically proven as much but from my observation its as if each human has their own " normal " range of anything..so when I see a patient I dont just see the lab results..I see the patient as a whole..that is making sure there is no complications overall.


Cos if we are too lab results oriented we could over treat or under treat cos some have apparent normal levels but end up with complications.

Also micro surges and dips in blood sugar levels cause the most damage..not always tru diet but tru stressful life and diet which promotes inflammation.
These spikes and dips can predispose a person to end organ damage.

So moderation is always the key to health..easily said but almost impossible to be done.
 

a-TB

Well-known member
As a doc I surely follow the 6.5-7% (48-53 mmol/mol) still till proven otherwise.

But on a personal observation I can safely say that there is no one size fit all for all human beings.

Some patients show no complications of any sort even though the Hb A1c is way off the mark and some have perfect control yet land up with complications.


Its as if each human has their own range of control which will be next to impossible to create a customized personal range.

For eg..my fathers HbA1c is 7-8% (53-64 mmol/mol), ...some docs suggested he start treatment and when he was put on treatment his blood sugar levels plunge too low.

He cant be on meds yet his body shows no signs and symptoms of diabetes and no end organ or small vessel complication at all!

Its as if his body functions perfectly fine with higher than the " normal" levels of blood sugar level.

What I am saying is not medically proven as much but from my observation its as if each human has their own " normal " range of anything..so when I see a patient I dont just see the lab results..I see the patient as a whole..that is making sure there is no complications overall.


Cos if we are too lab results oriented we could over treat or under treat cos some have apparent normal levels but end up with complications.

Also micro surges and dips in blood sugar levels cause the most damage..not always tru diet but tru stressful life and diet which promotes inflammation.
These spikes and dips can predispose a person to end organ damage.

So moderation is always the key to health..easily said but almost impossible to be done.
This kind of end to end approach centered on a patient is excellent .

Some doctors follow recommendations blindly. I am still not sure what the story is with respect to Cholesterol numbers. Not sure if statins are to be prescribed for marginally off people. Some are statin resistent.

There was a big deal about some new medicine called PCSK9 inhibotors that the drug makers priced at a very high level. Now they are back tracking because insurance companies refuse to pay I think.

Many South Asians have high triglycerides numbers but is that a concern to be treated with medications. What number is considered high and how do these researchers come up with the right numbers? It is hard to put everyone in the same bucket.

Are we all supposed to eat 2000 calorie diet ? Most of us vary in height and weight and such recommendations make no sense.

There is much research to be done that takes into account the gender of a patient.

Glad to see doctors who are smart and use these guidelines wisely in the context of a patient's personal history
 

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