Dr Robert Gabbay Explains Controversy Over Recent A1C Guidelines

Robert A. Gabbay, MD, PhD, FACP, senior vice president and chief medical officer of Joslin Diabetes Center, explains why the Joslin Diabetes Center and the American Diabetes Association oppose the decision by the American College of Physicians (ACP) to recommend a higher A1C target across the board.

Why did Joslin Diabetes Center feel it was important to join with the American Diabetes Association to oppose the decision by the American College of Physicians to change its A1C guidelines? 
The development and publication of the ACP guidelines really disturbed a number of us in the diabetes community, and that’s why I think you could see that there is a pretty swift response that was coordinated across multiple organizations, that rarely work so quickly together, and, so, in a sense, it was pretty unusual. I think there’s much in the ACP guidelines that are very helpful. I think there was some confusion that was created, perhaps, and we feel they’ve missed the boat on a number of key issues.

The goals for A1C really need to be individualized. We clearly agree that for the elderly with limited lifespan and poor quality of life, those A1C goals need to be much higher. What ACP missed was the fact that people earlier in the course of the disease, without a lot of complications, really should be managed to a much lower A1C goal, and there’s evidence to support the benefit of that.

The other big area that was not addressed in the guidelines and we incorporated in the Joslin guidelines, that are now being published, was the incredibly exciting, new data around how to prevent cardiovascular disease with the right choice of treatment for glucose control and the SGLT2 inhibitors and the GLP-1 agents. Both of those have demonstrated lower cardiovascular risk, and that really is a pretty dramatic change in the way we manage our patients. The ACP, sadly, didn’t really recognize that or include that as an important piece of the recommendations and guidance. 
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