Once diagnosed with type 2 diabetes, patients are often advised to take what is known as a glycated hemoglobin (HbA1c) test in order to keep blood sugar levels under control.
The test averages a person's blood sugar levels over the past 2 or 3 months, with an HbA1c score of 6.5 percent indicating diabetes.
Patients who score over 6.5 percent would then be prescribed a daily insulin based treatment which they can inject themselves. Rapid-acting injections take effect within 5 to 15 minutes but last for a shorter time of 3 to 5 hours. Long-acting injections take effect after 1 or 2 hours and last for between 14 and 24 hours.
But some studies have pointed out that the HbA1c test may currently be overused in the U.S., and they have suggested that such over-testing may lead to over-treating patients with hypoglycemic drugs.
These drugs often have a range of side effects, such as gastrointestinal problems, excessively low blood sugar, weight gain, and even congestive heart failure.
Additionally, as some researchers have pointed out, "Excessive testing contributes to the growing problem of waste in healthcare and increased patient burden in diabetes management."
In this context, the American College of Physicians (ACP) set out to examine the existing guidelines from several organizations and the evidence available in an effort to help physicians make better, more informed decisions about treating people with type 2 diabetes.
Their guidelines were published in the journal Annals of Internal Medicine.
An A1C of 7 to 8 percent is recommended
As the ACP explain, the current rationale behind the existing recommendations of a score of 6.5 percent — or below 7 percent — is that keeping blood sugar this low would decrease the risk of microvascular complications over time. However, the ACP found that the evidence for such a reduction is "inconsistent."
As Dr. Jack Ende — the president of ACP — puts it, "[Our] analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7 percent or less compared to targets of about 8 percent did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms."
He continues, saying, "The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7 percent and 8 percent will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs."
Additionally, the ACP recommend that patients who are 80 years old and above, or who live with chronic illnesses such as dementia, cancer, or congestive heart failure, receive a treatment that focuses on reducing high blood sugar-related symptoms instead of lowering HbA1c levels.
The reason for this is that for patients in this category, the potential side effects of hypoglycemic drugs outweigh the advantages.
"Results from studies included in all the guidelines demonstrate that health outcomes are not improved by treating to A1C levels below 6.5 percent," Dr. Ende explains.
"However, reducing drug interventions for patients with A1C levels persistently below 6.5 percent," he continues, "will reduce unnecessary medication harms, burdens, and costs without negatively impacting the risk of death, heart attacks, strokes, kidney failure, amputations, visual impairment, or painful neuropathy."
"Although ACP's guidance statement focuses on drug therapy to control blood sugar, a lower treatment target is appropriate if it can be achieved with diet and lifestyle modifications such as exercise, dietary changes, and weight loss."
Dr. Jack Ende