Skip Navigation
Menu
Ideas and Opinions |7 August 2018

Guidelines Versus Guidelines: What's Best for the Patient?

Boris Draznin, MD, PhD; David M. Nathan, MD; Mary T. Korytkowski, MD; Marie E. McDonnell, MD; Sherita Hill Golden, MD, MHS; Mark H. Schutta, MD; William T. Cefalu, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 22 May 2018.
  • University of Colorado Anschutz Medical Campus, Aurora, Colorado (B.D.)
    Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.M.N.)
    University of Pittsburgh, Pittsburgh, Pennsylvania (M.T.K.)
    Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (M.E.M.)
    Johns Hopkins University School of Medicine, Baltimore, Maryland (S.H.G.)
    University of Pennsylvania, Philadelphia, Pennsylvania (M.H.S.)
    American Diabetes Association, Arlington, Virginia (W.T.C.)

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0939.

    Corresponding Author: Boris Draznin, MD, PhD, 12801 East 17th Avenue, Aurora, CO 80045; e-mail, Boris.Draznin@ucdenver.edu.

    Current Author Addresses: Dr. Draznin: 12801 East 17th Avenue, Aurora, CO 80045.

    Dr. Nathan: 50 Staniford Street, Suite 340, Boston, MA 02114.

    Dr. Korytkowski: 3601 Fifth Avenue, Falk Building, Room 560, Pittsburgh, PA 15213.

    Dr. McDonnell: 75 Francis Street, Boston, MA 02115.

    Dr. Hill Golden: 1830 East Monument Street, Room 9052, Baltimore, MD 21287.

    Dr. Schutta: 3400 Civic Center Boulevard, Suite 4-900W, Philadelphia, PA 19104.

    Dr. Cefalu: 2451 Crystal Drive, Suite 900, Arlington, VA 22202.

    Author Contributions: Conception and design: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Analysis and interpretation of the data: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Drafting of the article: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Critical revision for important intellectual content: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Final approval of the article: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Collection and assembly of data: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

×
FULL TEXT
Diabetes mellitus is a chronic disease that frequently leads to debilitating and life-threatening complications. Optimally managing type 2 diabetes entails avoiding acute metabolic complications and preventing long-term microvascular conditions (retinopathy, nephropathy) as well as neuropathic and macrovascular complications (cardiovascular and peripheral arterial disease) that reduce quality of life and longevity. Epidemiologic and landmark randomized clinical trials in both types of diabetes established the primacy of glycemia as a causal factor for microvascular complications (1, 2). The DCCT (Diabetes Control and Complications Trial) (1) and UKPDS (United Kingdom Prospective Diabetes Study) (2) in type 1 and type 2 diabetes, respectively, demonstrated the benefits of achieving a hemoglobin A1c (HbA1c) level of 7% among participants in the intensive versus standard treatment groups. These studies form the basis for most guidelines that recommend an HbA1c level below 7%, provided that this goal can be achieved safely (3). Modification of these glycemic targets is recommended for older adults with limited life expectancy and for persons at high risk for hypoglycemia or other untoward effects (3).
The recently published guideline from the American College of Physicians (ACP) (4), recommending an individualized approach to glycemic targets in older populations with a limited lifespan or multiple comorbid conditions, is in line with previously published guidelines from the American Diabetes Association and other organizations (3). However, as clinicians, we believe that other ACP recommendations, particularly those that advocate relaxation...
FULL TEXT
PDF
Not Available
Citations
Citation

Draznin B, Nathan DM, Korytkowski MT, et al. Guidelines Versus Guidelines: What's Best for the Patient?. Ann Intern Med. 2018;169:186–187. [Epub ahead of print 22 May 2018]. doi: https://doi.org/10.7326/M18-0939

Download citation file:

© 2019

×
Permissions

Published: Ann Intern Med. 2018;169(3):186-187.

DOI: 10.7326/M18-0939

Published at www.annals.org on 22 May 2018

©
2018 American College of Physicians
6 Citations

Related Articles
Meta-Analysis: Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus
Annals of Internal Medicine; 141 (6): 421-431
Review: Exercise training reduces HbA1c levels but not body mass in type 2 diabetes mellitus
Annals of Internal Medicine; 136 (3): 100
Glycemic Control and Type 2 Diabetes Mellitus: The Optimal Hemoglobin A1c Targets. A Guidance Statement from the American College of Physicians
Annals of Internal Medicine; 147 (6): 417-422
Glimepiride Combined with Morning Insulin Glargine, Bedtime Neutral Protamine Hagedorn Insulin, or Bedtime Insulin Glargine in Patients with Type 2 Diabetes: A Randomized, Controlled Trial
Annals of Internal Medicine; 138 (12): 952-959
View MoreView Less

Journal Club
Review: In adults with type 1 diabetes, SGLT-2 inhibitors reduce HbA1c but increase diabetic ketoacidosis
Annals of Internal Medicine; 169 (2): JC3
In type 2 diabetes, weekly semaglutide reduced HbA1c and increased weight loss more than weekly exenatide ER
Annals of Internal Medicine; 168 (8): JC46
Self-monitoring of blood glucose did not improve HbA1c or QoL at 1 year in non–insulin-treated type 2 diabetes
Annals of Internal Medicine; 167 (8): JC46
In type 1 diabetes, education with either insulin pumps or daily injections did not differ for HbA1c at 2 y
Annals of Internal Medicine; 167 (4): JC15
View MoreView Less

Related Point of Care
Type 2 Diabetes
Annals of Internal Medicine; 171 (9): ITC65-ITC80
Type 2 Diabetes
Annals of Internal Medicine; 162 (5): ITC1
Type 2 Diabetes
Annals of Internal Medicine; 152 (5): ITC3-1
Type 2 Diabetes
Annals of Internal Medicine; 146 (1): ITC1-1
View MoreView Less

Related Topics
Cardiology
Coronary Risk Factors
Diabetes
Endocrine and Metabolism

Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.

CONTINUE WITH LIMITED ACCESS
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
acp link acp
silverchair link silverchair

Copyright © 2019 American College of Physicians. All Rights Reserved.

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Privacy Policy

|

Conditions of Use

This site uses cookies. By continuing to use our website, you are agreeing to our privacy policy. | Accept
×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×