tag:blogger.com,1999:blog-5121723593802011786.post6358265403831783269..comments2024-03-20T18:21:06.690-04:00Comments on Annals of Internal Medicine: Fresh Look Blog: What Should I Tell My Mom?American College of Physicianshttp://www.blogger.com/profile/15978682034152790218noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-5121723593802011786.post-46686176939214012512018-10-01T23:43:59.154-04:002018-10-01T23:43:59.154-04:00Unfortunately guidelines often mask the underlying...Unfortunately guidelines often mask the underlying data which drove their decisions, on both sides. From my albeit limited understanding of the data based on a much more nuanced understanding of faculty with whom I have worked, specifically using insulin to achieve tighter glycemic control results in increased mortality and morbidity to patients when A1c is driven below 8, which is NOT equivalent to the entire group of patients with A1c below 8 (for example, treating to A1c goal of 5.5 is universally considered dangerous, but we don't consider patients with a native A1c of 5.5 to be in danger of anything). However, that does not apply when better A1c is achieved with lifestyle changes and non-hypoglycemic medications, including the cardiovascular benefit of metformin having been demonstrated independent of A1c lowering. So, both the ACP and AACE A1c goals have their places.William Yanghttps://www.blogger.com/profile/05581920709461964839noreply@blogger.com