New guidelines for type 2 diabetes management

(Mel Soule) #1

There are new guidelines for how type 2 diabetes should be managed: the American College of Physicians is now recommending that patients should aim to have A1C levels — a measure of average blood sugar — between 7 percent and 8 percent. It was previously recommended that patients keep their A1C between 6.5 percent and 7 percent. (An A1C of 6.5 percent is the threshold for diabetes.) The doctors’ group found that keeping A1C below 7 percent did not lead to fewer heart attacks or strokes versus keeping it below 8 percent, but that more intensive efforts to get A1C below 7 percent had other adverse effects, including weight gain and hypoglycemia. Some clinicians are pushing back on the guidelines, however, noting that the American Diabetes Association generally recommends A1C levels below 7 percent.
Well thanks so much guys. A brave and courageous retreat in the face of the enemy.

Here is the link to the full guidelines
New ACP Guidance Statement

(matt ) #2

This is a horrible idea…unless they want to sell drugs. 7-8 is waaaay to high and the damage just keeps coming. 6.5 is too high honestly.

I assume this is more fear of going too low and if that is something that is possible then its something to be aware of. For the normal T2D person there is very little risk of that unless they are taking meds and doing keto and not tracking BG.

(Mel Soule) #3

@matt I could not agree with you more. One more example of health care is an oxymoron. The only thing being cared for is the providers, the payers and the drug makers. The only solution is to save ourselves.

(Candy Lind) #4

This REALLY pisses me off:
“Guidance Statement 4:
Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population.” Shadows of Scrooge and the “surplus population.” Because you’re over 80, you don’t deserve the same care? :face_with_symbols_over_mouth:

#5

Truth, sort of obvious what their agenda is by changing guidelines. It’s like lowering the BP recommendations.

(Sarah ) #6

You’re looking at this through the eyes of a health and wellness seeker. Dr’s are looking at damage control. Very different. Dr’s can’t make someone care about their health, and throwing more meds, or scolding them for being out of range, isnt going to help anyone. That’s not a Dr’s job. People need to take their health into their own hands. Keto or any healthy eating habits, are a great example. Diabetes would be essentially non existant except as a rare weird kids disease, if people owned their own health.

(Ken) #7

I’m showing my cynical side here, but the new guidelines look like a great idea to increase business for the “Diabetes Management Industry”.

(Mel Soule) #8

True, but whatever happened to that quaint promise “First do no harm”?

(Sarah ) #9

This isn’t about idealism. It isn’t a Dr’s job to save people from themselves. We don’t have enough drs as it is, and dm2 is almost completely treatable in its early stages, with out medical intervention. Dr’s have a right to limit their practice to things they can do, like deal with amputations or eye problems or such. Dr’s aren’t counselors or dieticians or physical therapists or grocery store owners. … the things that should matter to a early stage diabetic. We need to focus on increasing access to health, not complaining about making people feel more depandant and diseased

(You've tried everything else; why not try bacon?) #10

In line with another post, I’d like to point out that the thinking behind the change in the guidelines presupposes that the patient is eating lots of carbohydrate and managing glucose levels with insulin. This means that the risk of hypoglycemic episodes is very real, especially for Type I diabetics, since it is difficult to match your insulin with your carb consumption (see the Troy Stapleton videos that Low Carb Down Under has posted on its YouTube channel). For Type I diabetics on a low-carb, high-fat diet, hypos are not really a concern, because glucose doesn’t spike so much, and they need less insulin, hence there is much less risk of an episode. Type II diabetics on Metformin don’t have nearly the same risk of hypos, but I believe that there is some risk if they are on an insulin preparation.

The moral of the story: KCKO! :bacon::bacon:

(Jeanne Wagner) #11

Yezbut, the doctors won’t even mention keto. And they need to so the patients have a source of information in order TO take their health in their own hands. As we know most don’t even know about it or are against it (Down with keto, we hate it!). Grumble grumble, just venting. I know that is changing, but ever sooooo slowly. If every doctor just handed a copy of <insert awesome keto book title here, there are so many to choose from at this point> to their patients that would go a long way to helping them. You know, like they hand out little guideline diets to thier freshly diagnosed T2DM patients. At least mine did.

(Jeanne Wagner) #12

Holy crap. Even 12 years ago when I was diagnosed with T2DM my doctor told me he wanted to see me under A1C of 5.5. He knew then. I since left his care since he insisted my blood pressure remain under 100/70 in order to minimize stroke risk… after walking around like a zombie and almost passing out every time I stood up with a BP of 90/50 I fired him.

(Todd Allen) #13

I’ve found that when my ketone levels are high such as after several days of fasting I can push my blood sugar quite low without any adverse effects. I wonder if this is common/universal and if so could it be leveraged to the advantage of diabetics allowing targeting normal blood glucose values instead of the high levels chosen in fear of hypos. Ideally people would do this eating strict keto or fasting, but maybe this could also be a good use for exogenous ketones if/when they become affordable.

(Dameon Welch-Abernathy) #14

There’s one statement I can kinda, sorta agree with in this report:

Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%.

The rest of it reads like a way to keep people just sick enough to keep buying the meds, but not actually rid patients of this treatable condition.

(Mel Soule) #15

@phoneboy Absolutely. Any strategy to de-medicate or un-medicate a patient is going the right way. Like us.