Diabetics caught up in medical experts’ dispute over key blood sugar metric

acp-A1C-300x184What are patients supposed to do when medical experts feud over key disease metrics like the optimal blood sugar level  for diabetics?

Here we go again, figuring out medical figures:  That’s because the American College of Physicians and the American Diabetes Association are tussling over the much-watched blood sugar test — the hemoglobin A1c. It’s also known just as the A1C or the HbA1c, or glycohemoglobin test.

As the Mayo Clinic describes the A1C, it “reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications.”

The physicians’ college noted that multiple medical groups have reviewed research on optimal A1C measures, developing different standards. So the ACP, representing more than 150,000 doctors, mostly internists, decided to conduct its own literature and practice review.

Many organizations, including the diabetes association, have urged patients to get the A1C low — in the 6.5 to 7 percent range. But the internists disagree, saying it is fine if patients target a reading in the 7- to 8-percent range, in close collaboration with their own doctors.

Dr. Jack Ende, president of the internist group, told NPR, “There are harms associated with overzealous treatment or inappropriate treatment focused on A1C targets. And for that reason, this is not the kind of situation where the college could just sit back and ignore things.”

As NPR added to explain his view:

Some studies have shown that people who have aggressively pushed to lower their blood sugar are at somewhat higher risk of premature death. People also suffer from low blood sugar as a result of aggressive treatment.

The Washington Post explained that:

[T]he harms [of pushing for lower A1C readings] include ‘hypoglycemic events,’ commonly known as low blood sugar, which, in the short term, can cause people with diabetes to feel woozy, lose track of their surroundings or lose consciousness. In the long run, they can lead to cardiovascular problems. …The group also concluded that the burden of taking one or more medications to achieve tight glucose control can be greater than the benefit, in both side effects and financial cost. Side effects include weight gain, gastrointestinal problems, congestive heart failure, joint pain, fractures and genital fungal infections.

But the American Diabetes Association and endocrinologists quoted by the Post disagreed with the internists’ recommendations, published in the group’s journal, The Annals of Internal Medicine. The influential diabetes group said it stands by its advice for patients’ to seek a lower A1C, noting that some of the internists’ questions on medication woes have been addressed by newer drugs with fewer side-effects.

In my practice, I see the significant harms that patients suffer while seeking medical services, and their confusion, frustration, and even anger when doctors and medical researchers disagree on standards of care. Diabetes, without a doubt, is a historic health menace, as the Washington Post reported:

The condition can lead to complications that include strokes, heart problems, kidney disease, blindness and amputations. In 2016, diabetes was the seventh-largest killer of Americans, with 80,000 deaths attributed to the disease, according to the National Center for Health Statistics.

Doctors and patients need to control the disease and its harms, especially for Type 2 patients with diabetes of the far more common kind. Type 1 diabetics tend to be young, and they make too little or no insulin at all, as their bodies attack pancreas where this crucial hormone gets made. Type 2 diabetics tend to be middle-aged and older. Their bodies do not make or use insulin well.

Weight control is important in treating this condition, as are diet and exercise. It’s unacceptable how many diabetics grapple with not only controlling their illness but also the skyrocketing price of insulin, which has been jacked up with little discernible reason by Big Pharma companies.

Those profit-focused drug makers also have been abetted by some doctors and advocacy groups that also have “medicalized” or sounded dodgy alarms not just about the prevalence of diabetes but also other conditions, creating a crush to diagnose, medicate, and over-treat patients for conditions like “prediabetes.” The tiff over A1C standards, of course, has come hard on the heels of  medical experts’ arguing over hypertension, heart disease, and what ought to be best practices on patients’ blood pressure readings.

Common sense and moderation can be effective guides to dealing with a disputatious world. Patients should talk to their doctors, discuss their individual situations, and seek out the care that works best for them, with medical metrics serving as helpful, reasoned, and reasonable guides, but not absolutes.

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