This is the current release of the guideline.

On the basis of the review of the available guidelines, the American College of Physicians Clinical Efficacy Assessment Subcommittee recommends the following:

Statement 1: To prevent microvascular complications of diabetes, the goal for glycemic control should be as low as is feasible without undue risk for adverse events or an unacceptable burden on patients. Treatment 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.

The goals for glycemic control should be as low as is feasible without undue risk for adverse events, such as hypoglycemia. Clinicians should counsel patients and emphasize the importance of good glycemic control. Clinicians should discuss treatment goals with each patient and agree jointly on goals that are feasible, given the patient's comorbid conditions, preferences, and ability to manage the treatment regimen. Therapy in many patients should be targeted to achieve a hemoglobin A1c value less than 7% to reduce the risk for complications from diabetes. However, this goal will not be appropriate for all patients. In patients who are older or frail, at increased risk for adverse complications from tight control, or have substantially reduced life expectancy from comorbid conditions, hemoglobin A1c goals higher than 7% may be appropriate. In patients who are at increased risk for microvascular complications, stringent targets may be appropriate.

Statement 2: The goal for hemoglobin A1c level should be based on individualized assessment of risk for complications from diabetes, comorbidity, life expectancy, and patient preferences.

With consideration of the importance of glycemic control, the goals for glycemic control should be individualized on the basis of the life expectancy of the patient, presence or absence of microvascular and macrovascular complications, risk for adverse events related to glucose control, and patient preferences. Less stringent targets may be appropriate in patients who have short life expectancy or are at higher risk for adverse complications of therapy.

Refer to the original guideline document for recommendations for future research.

None provided

This guidance statement is derived from other organizations' guidelines and is based on an evaluation of strengths and weaknesses of the available guidelines.

Not applicable: The guideline was not adapted from another source.

2007 Sep

American College of Physicians - Medical Specialty Society

American College of Physicians

Clinical Efficacy Assessment Subcommittee of the American College of Physicians

Authors: Amir Qaseem, MD, PhD, MHA; Sandeep Vijan, MD, MS; Vincenza Snow, MD; J. Thomas Cross, MD, MPH; Kevin B. Weiss, MD, MPH; Douglas K. Owens, MD, MS

Clinical Efficacy Assessment Subcommittee Members: Douglas K. Owens, MD, MS (Chair); Donald E. Casey Jr., MD, MPH, MBA; J. Thomas Cross Jr., MD, MPH; Paul Dallas, MD; Nancy C. Dolan, MD; Mary Ann Forciea, MD; Lakshmi Halasyamani, MD; Robert H. Hopkins Jr., MD; and Paul Shekelle, MD, PhD

Potential Conflicts of Interest

Grants received: V. Snow (Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Novo Nordisk, Bristol-Myers Squibb, Pfizer Inc., Merck Pharmaceuticals)

Receipt of payment for manuscript preparation: S. Vijan (American College of Physicians)

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on October 9, 2007. The information was verified by the guideline developer on June 2, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.