American College of Physicians publishes new A1c guidelines. We strongly disagree.

ideal-a1c-for-type-2-diabetes

ACP A1c Guidelines

This week, the American College of Physicians published new guidance on the treatment of type 2 diabetes. Like many in the diabetes community, I was left shaking my head about the recommendations, which include a target A1c for people with type 2 diabetes between 7-8%. This is in contrast to the longstanding ADA recommendation of 7% for all people with diabetes.

ideal-a1c-for-type-2-diabetes

Whoa. That’s Confusing.

Even more confusing is the recommendation that doctors ‘de-intensify’ treatment for people with type 2 diabetes who are meeting their A1c target. That’s like telling a teenager ‘Just drive faster and don’t worry too much about the speed limit.’

ideal-a1c-for-type-2-diabetes

This new guidance is baffling from a medical point of view, because it’s known that having an A1c over 7% significantly increases your risk for complications, including severe visual impairment (blindness), extensive nerve damage, and kidney disease, just to name a few.

Let’s Talk Management. Real Management.

But what shocks me most is the message of disempowerment that the ACP is sending to people with diabetes. Managing isn’t always easy, but I am a firm believer that it’s doable. And we have plenty of evidence that it is! When I read these recommendations, it tells me that that the American College of Physicians doesn’t believe that people with diabetes can manage it well. I get the impression that they believe that people aren’t capable of keeping their blood sugars in their target range; those that can don’t have the ability to deal with low blood sugars.

So Then – What is an Ideal A1c for Type 2 Diabetes?

This sends the message that many doctors would rather change the rules to give their patients (and themselves) the impression they are providing good care, rather than actually providing it. But no matter what the rules are, they do not change the fact that having an A1C above 7% is not good for you. The research clearly shows that most people’s ideal A1c should be below 7% (and some say 6.5%) to reduce the risk of diabetes-related complications.

ideal-a1c-for-type-2-diabetes

We Deserve Better

People with type 2 diabetes deserve better from the American College of Physicians. They deserve better medical care, but just as importantly they deserve to have health care teams (and systems) who believe in them and who will empower them to play the key role in their self-care. So many people with diabetes want to manage better, but they’re not confident that they can. With this guidance, the American College of Physicians isn’t doing much to help.

At One Drop, we’re confident that people can live well with diabetes. We know from experience that by giving people education, tools, and support, they will gain the confidence they need to get there. When people meet their ideal A1c, we celebrate with them, and we work with them to stay on track to maintain their gains. Just take a look at all of our clinical trials.

We see evidence that people can live great lives while managing diabetes well every day.

We believe that people with diabetes should be empowered to take care of themselves, and we’re committed to standing by their side every step of the way.

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Mark Heyman, PhD, CDE
Mark Heyman, PhD, CDE

Dr. Mark Heyman is a Clinical Psychologist and Certified Diabetes Educator, with expertise in the emotional and behavioral aspects of diabetes, including changes that improve physical and mental health outcomes in people with diabetes. When Mark was diagnosed with type 1 diabetes in 1999, he was frustrated by the lack of resources available to help people navigate the behavioral and emotional challenges of living with the disease. As a psychologist and CDE, Mark now uses his knowledge and experience to tackle the complexities associated with diabetes. Mark developed and currently leads the One Drop | Experts program. He received his PhD in Clinical Psychology from The George Washington University and completed his psychology internship and post-doctoral fellowship at the UCSD School of Medicine. Mark holds an appointment as a voluntary Assistant Clinical Professor in the UCSD Department of Psychiatry. In his spare time, Mark can be found performing with his improvisational comedy team *Inside Joke*. Find Mark on Twitter: @DiabeticPsych