The American College of Physicians (ACP) published a new target hemoglobin A1c for people with type 2 diabetes, raising the recommended level for most patients to a range of between 7 percent and 8 percent. Hemoglobin A1c levels below 7 percent do not reduce rates of heart disease, stroke, or premature death and are associated with substantial harms to patients related to treatment burdens and risk of severe hypoglycemia. ACP also recommends that clinicians prescribe pharmacologic therapy only for symptom control for patients with a life expectancy of less than 10 years and “de-intensify” medications for patients of any age who achieve an A1c below 6.5 percent.
Some clinicians may conclude that tight diabetes control is not as important as previously understood. However, the harmful effects and lack of benefits of tight control only occur when lower A1c is achieved with medication.
Research shows that plant-based dietary patterns prevent diabetes, reduce insulin resistance, improve beta cell function, and improve blood glucose levels. Plant-based foods provide important nutrients that lower blood pressure, improve cholesterol levels, and protect against heart disease, stroke, and certain cancers more effectively than medications.
- Qaseem A, Wilt TJ, Kansagara D, et al. Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians. Ann Intern Med. 2018;168:569-576.