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Ideas and Opinions |21 August 2018

Brief Commentary: The Glycemic Target Guideline Controversy: Same Evidence, Different Perspectives, and a Proposal for Common Ground

David C. Aron, MD, MS; Paul R. Conlin, MD; Leonard Pogach, MD, MBA

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Author, Article, and Disclosure Information
This article was published at Annals.org on 26 June 2018.
  • Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio (D.C.A.)
    VA Boston Healthcare System, West Roxbury, Massachusetts (P.R.C.)
    Veterans Affairs Central Office, Washington, DC (L.P.)

    Disclaimer: The views expressed here are not to be construed as those of the U.S. Department of Veterans Affairs or the U.S. Department of Defense.

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1342.

    Corresponding Author: Leonard Pogach, MD, MBA, Veterans Affairs Central Office, Office of Specialty Care (P11), 810 Vermont Avenue, Washington, DC 20420; e-mail, Leonard.Pogach@va.gov.

    Current Author Addresses: Dr. Aron: Director, Clinical Program Research and Evaluation, Louis Stokes Cleveland VA Medical Center Administrative, Building EUL 5M677, 10701 East Boulevard, Cleveland, OH 44106.

    Dr. Conlin: Chief, Medical Service, VA Boston Healthcare System, 1400 Veterans of Foreign Wars Parkway, West Roxbury, MA 02132.

    Dr. Pogach: Veterans Affairs Central Office, Office of Specialty Care (P11), 810 Vermont Avenue, Washington, DC 20420.

    Author Contributions: Conception and design: L. Pogach.

    Drafting of the article: L. Pogach.

    Critical revision of the article for important intellectual content: P.R. Conlin, L. Pogach.

    Final approval of the article: D.C. Aron, P.R. Conlin, L. Pogach.

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Editors' Note: This commentary was selected for publication from among several submitted in response to a call for readers' perspectives on treatment targets for type 2 diabetes.
The 2007 American College of Physicians guidance statement for type 2 diabetes recommended that “[t]reatment goals should be based on a discussion of the benefits and harms of specific levels of glycemic control with the patient. A hemoglobin A1c level less than 7% based on individualized assessment is a reasonable goal for many but not all patients” (1). At that time, recommended general target levels for hemoglobin A1c ranged from less than 6.5% (American College of Clinical Endocrinologists) to less than 7% (American Diabetes Association) and stratified target levels from less than 7% to less than 9% (U.S. Department of Veterans Affairs and Department of Defense).
Despite 10 years of iterations of these and other guidelines, recommendations remain heterogeneous (2). However, a public—and sometimes acrimonious—debate is now ongoing and is frequently documented in medical journals and the national press (3). The same body of evidence is considered by all, but the interpretation of that evidence differs among organizations that develop their own guidelines using varying criteria. This leads to conflicting presentations of the evidence to the public and further confusion among practitioners and patients alike. Rather than speculating about why interpretations differ, we propose action to address the conflict. Specifically, we recommend developing a collaboration among federal agencies, the private sector, and academia that focuses...
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Aron DC, Conlin PR, Pogach L. Brief Commentary: The Glycemic Target Guideline Controversy: Same Evidence, Different Perspectives, and a Proposal for Common Ground. Ann Intern Med. [Epub ahead of print 26 June 2018]169:248–249. doi: 10.7326/M18-1342

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Published: Ann Intern Med. 2018;169(4):248-249.

DOI: 10.7326/M18-1342

Published at www.annals.org on 26 June 2018

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