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American College of Physicians new guidelines

LittleGreyCat

Well-Known Member
Retired Moderator
Messages
4,386
Location
Suffolk, UK
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
Apologies if this has already been covered.
I've just read that this year the ACP have relaxed their guidelines for target HbA1c from 6.5% to between 7% and 8%.

Those hitting 6.5% or below could relax their diet or reduce their medication.

Having just started getting back on the wagon and remembering how tough it can be, this is a tempting prospect.
With indulging myself shamelessly my HbA1c is up from 7% to 8.7% so getting below 8% is a much easier target than getting back down to 6.5%.

What is the general feeling about this?
 

Was that adjustment in the ACP Guidelines age related perchance? I know in UK, targets for the more mature into really rather mature tend to be a bit higher that for the rest of us.

Personally, I would like to remain inthe domains of the non-diabetic (under42). Aside from my diagnostic A1c my reviews have been low mid-thirties.

I don't chase lower and lower A1cs, because I have a life and sometimes the unwelcome bits make themselves known. I don't need to beat myself with a stick.

I feel keeping a neat A1c helps reduce the risk of those ailments and conditions developed or progressed by high blood sugars. Of course, I don't have a lifetime warranty on that. None of us do. All each of us can do is decide where we will set out own risk dials and own it.
 
Have you got a link for that? I would be interested to know whether that is for T1 or T2 and also, as @AndBreathe said, whether it's age related...

My T2 dad at 92 is quite happy to have a slightly higher hba1c and no medication. The risk of hypos (and hence falls) from gliclazide far outweighs the benefit of a lower level...
 
My own belief is that you're inviting complications but there are other factors as in age of patient & existing comorbidity
 
Any search I do shows the levels haven't changed since 2018.

I thought the levels are due to be reconsidered but they base the diagnosis points as a percentage of the population, so as the overall population gets sicker and fatter and has higher levels of diabetes, then the baselines will gradually increase.

It has nothing to do with how much or how little we can relax our diets, but everything to do with keeping costs and numbers down. Doesn't mean we are any healthier or less deserving of help and support but that we can be headed off at the first hurdle.

I'm not going to let any lowering of baselines lessen my self care.
 
Here in the UK NICE too have relaxed the targets in the May update to the guidelines. It is applied to anyone using a hypoglycemic medication and is aimed at preventing hypo events. My GP has already insisted that I raise my targets to 8.5 average with minimum 7 mmol/l and 15 mmol and above as being too high. a level of 12 is ok according to my GP. These are the levels that T1D are advised to follow in my CCG area, and when I went into hospital it was the levels they applied to me even though I was not on insulin. It got to the point that when I registered some 6 mmol readings I was force fed digestives or cake. My 4.9 totally freaked them out when I finally conquered Eatwell. So yes, this is the new regime it seems.
 
Thanks @Oldvatr (using the App and not finding the User ID function).
I am not on hypoglycemic medication although I am "mature" so I will be interested to see what my DSN says.

ACP recommends moderate blood sugar control targets for most patients with type 2 diabetes | ACP Online

Philadelphia, March 6, 2018 – Patients with type 2 diabetes should be treated to achieve an A1C between 7 percent and 8 percent rather than 6.5 percent to 7 percent, the American College of Physicians (ACP) recommends in an evidence-based guidance statement published today in Annals of Internal...
www.acponline.org

Found this by a specific search for ACP.
Apparently dates back to 2018.

I note that the report seems to say that a higher HbA1c doesn't seem to do any harm up to 8% so why spend money on drugs to get below 6.5%?
This is a stronger argument for the USA where drug prices are criminal.
However they do claim a wide ranging study.

I searched for NICE recommendations but the first few hits are all from 2015.

In my personal case, with an HbA1c of 7% I persuaded my surgery to start me on Alogliptin to see if I could relax my dietary control a bit and still hit decent numbers.
They said that 7% was the target for people already taking Alogliptin but agreed to give it a go.

As you may know from other posts I have had a tough year with a bladder cancer diagnosis and treatment so the eating plan went right out of the window.
Considering that, 8.7% may not be a bad result.
I have fitted a Libre 2 and with a bit of fasting my numbers are already back in the green so grim determination should get my numbers down again.
It would be nice if the determination only had to get me down by 0.7% and not 2.2%.

Off on a long holiday soon which makes tight control more difficult so having treat days with less guilt would be good.
 
Just adding a note to say that all drugs have side effects so relaxing targets to reduce or cease drug use seems a strong argument.

Also noting that my exercise levels have gone down a lot because I am not currently cycling and I used to go on a 20-30 mile ride once a week.
When I get on my bike now I can tell how far my fitness levels have fallen.
 
A large cohort study done some time ago determined that the standard thresholds for pre-diabetes and full-blown were not appropriate for the older age groups. The current ones (42 and 48) were fixed decades ago on the basis of a single study of a bit more than a hundred individuals none of whom was aged above 39. For someone such as myself aged 75 the threshold for pre-diabetes should be about 47, not 42, was the conclusion of that study.
 
Link please?
That sounds an interesting study.
 
I'm 80 so presumably in the "really rather mature " category now and for the most part I keep my HbA1c results to low pre-diabetic - high end normal figures and my finger pricks within the range 5-7.5 , currently without diabetic medication or exercise - just eating a low carb/ketogenic type diet. My GP has never suggested these levels are too low - he's always well pleased with my HbA1cs, and as long as I can easily keep to them I see absolutely no reason to relax them. I enjoy what I eat, and would do serious battle with anyone who might try to get me to stuff myself with carbs ever again,

(I do have other issues mainly arthritis and slightly erratic BP, and I often wish that they were as easy to live with as T2 has been for me... )
 
LittleGreyCat said:
Link please?
That sounds an interesting study.
Click to expand...

Preventing misdiagnosis of diabetes in the elderly: age-dependent HbA1c reference intervals derived from two population-based study cohorts - BMC Endocrine Disorders

Background Measurement of gylcated hemoglobin A1c (HbA1c) plays a central role in monitoring quality of antidiabetic therapy and in the diagnosis of diabetes. Several studies report increased levels of HbA1c in nondiabetic elderly. However, this observation did not reach incorporation into daily...
bmcendocrdisord.biomedcentral.com
 
Interesting that the effect seems to be more pronounced for women and there does seeem to be a slight association with BMI for them, but not for men. Mind you, the graphs are progression lines, not directly reporting the actual data.
 
Gave a win for the attitude & positive response.

A hug for the diagnosis & juggling everything into manageable levels.
 
Well mine normally up near or sometimes above 8% and has been for years.and apart from not having the energy I used to have which doctors etc put down to my age 75 I have no other ill effects it would appear we are all so different I'm unable to feel any change if my morning BG is 6 or 10
 

A1c chart: Test, levels, and more for diabetes

The A1C test shows average blood sugar levels over the past 2–3 months. It can help doctors diagnose diabetes and check how well the treatment works.
www.medicalnewstoday.com
If you look at their declared source reference, then this site gets a mention. Most of th info in the article is USA sourced.

My GP in the UK has asked me for many years now to aim for a bgl average of 7 mmol/l, and recently he has asked me to raise my HbA1c to 56 mmol/Mol otherwise he will stop my medications. He considere my current 46 as being too low. for someone of my age and comorbidities.
 
Returning to this now I'm back in the UK.
Despite some indulgences when away on holiday, that is a fairly relaxed approach to diet, my HbA1c is now 7.2%.
From the NICE link above it seems that as I am not yet on any medication with hypoglycemia risk my target is still 6.5%.
However as I am now below 7.5% the push to start me on more medication has gone away.
Hopefully my next HbA1c will be 7% or lower.

Thanks for all the input.

It seems that the USA may be a bit more relaxed than the UK about target levels for the over 60s.
 
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