New Diabetes Guidelines Create Controversy

The American College of Physicians (ACP) has just released new guidelines for the treatment of diabetes, especially when treating older people.

The standard recommendation, agreed upon by a number of medical associations, including the American Diabetes Association (ADA), recommends keeping A1c levels below 7% in anyone with diabetes. However, after reviewing a variety of guidelines, the ACP published a paper in the Annals of Internal Medicine that finds that such a low A1c level, especially in older diabetics, does more harm than good. (Don’t know what A1c is?
See our blog post here, which includes the ADA’s guidelines for A1c.)

The ACP has relaxed the commonly-used guideline of keeping A1c below-7% because some of the medications used to reduce A1c bring with them side effects that decrease
the patient’s quality of life.

They are especially concerned about the elderly population, in which 1 in 4 people have diabetes.  Older patients often have more than one chronic diseases, and may take many different medications. As a consequence, the potential for drug interactions increases.

All people who suffer from multiple chronic conditions, including renal failure, liver failure, and-stage disease complications, cognitive impairment, advanced microvascular or macro vascular complications, and any conditions that limit life expectancy, share the same risks as the elderly.

The ACP also notes that keeping A1c levels below 7% increases the risk of hypoglycemia (low blood sugar), whose symptoms include lightheadedness, fainting, and fatigue.

This new recommendation has not been accepted by other medical organizations.
In particular, the ADA, has publicly rejected the new guidelines.

What all sides agree on, however, is that doctors need to look at the entire medical picture when setting A1c targets. With diabetes, one size does not fit all. Especially with patients who have other chronic diseases, and are taking multiple medications, a personalized plan must be developed to balance the risks and benefits of blood sugar management.

At Atlantic Coast Healthcare and Rehabilitation Center, in Lakewood, NJ, our doctors are always on top of new guidelines in disease management. We consider all factors when drawing up a personalized plan for each of our residents. Whether your loved one has diabetes or another chronic illness, you can be sure that our doctors, nurses, nutritionists, and therapists will take all factors into account to make sure they have the best health
and the best quality of life possible.

Want to discuss your loved one’s needs? Contact us at 732-364-7100, or by clicking here.