AACE Announces New A1c Standard of 6.5% or Lower

AACE Announces New A1c Standard of 6.5% or Lower

Medscape Medical News 2005. © 2005 Medscape

Terry Hartnett

May 24, 2005 (Washington) — Physicians need to take a stronger, more relentless approach to the treatment of patients with diabetes and to diagnose aggressively the disease in at-risk patients, said Paul Jellinger, MD, MACE, at a briefing here prior to the start of the American Association of Clinical Endocrinologists (AACE) 14th Annual Meeting and Clinical Congress.

Dr. Jellinger is the current president of the American College of Endocrinology (ACE), the educational and research group of AACE, former president of AACE, and professor of medicine on the voluntary faculty at the University of Miami in Florida.

Dr. Jellinger announced a new A1c standard of 6.5% or lower for patients with type 2 diabetes. The new standard is part of a more comprehensive effort to prevent diabetes complications. AACE is embarking on this effort following the results of a report outlined at the briefing that showed two thirds of Americans with type 2 diabetes are not in control of treating the disease. The majority of people with diabetes in all 50 states had A1c levels above the guideline, and 61% had no knowledge of the A1c test or of their own personal A1c level.

"The medical community needs to intervene earlier and more aggressively to control patients' blood sugar levels because of the link between high A1c levels and diabetes-related complications," said Jaime A. Davidson, MD, chairman of the AACE/ACE consensus conference that issued the report. "This may mean adding a medicine or a combination of medicines that help treat diabetes in different ways to a person's treatment regimen of diet and exercise," Dr. Davidson told attendees.

Daily blood sugar levels should be lower than 110 mg/dL before eating breakfast in the morning and lower than 140 mg/dL two hours after eating a meal, said Dr. Jellinger. "Blood sugar control is worsening today while blood pressure and cholesterol levels are improving," Dr. Jellinger said.

Dr. Jellinger stressed the importance of diagnosing diabetes early. AACE is recommending that physicians routinely give a two-hour 75-g glucose challenge test to all patients who have risk factors for diabetes. These include the following: family history, obesity, sedentary lifestyle, race/ethnicity (African Americans, American Indians, Asians, Pacific Islanders, and Hispanic Americans are all at high risk for diabetes), gestational diabetes during pregnancy, delivery of a larger than average-weight baby, polycystic ovary syndrome, peripheral vascular disease, high blood pressure, high cholesterol levels, and coronary heart disease.

"Even if the high-risk patient has a normal fasting blood sugar level, the physician should conduct the glucose challenge test," Rhoda H. Cobin, MD, clinical professor of medicine at Mount Sinai School of Medicine in New York, cochief of Mount Sinai's Thyroid/Endocrinology Clinic and the incoming ACE president, told Medscape. "In the average practice, the physician has so little face time with the patient," Dr. Cobin noted. "That is why AACE urges physicians to quickly bring diabetes to the forefront with the patient. Stress the importance of diagnosis and of managing the condition," Dr. Cobin urged.

Once a diagnosis is made, AACE advised frontline physicians to "be relentless" in treating diabetes. "'Do not tell the patient to watch their blood sugar levels and come back in six months," said Dr. Cobin. AACE is also recommending combination drug therapy for patients who do not have control of their blood sugar levels.

Dr. Cobin's message to practitioners regarding diabetes management, including drug therapy, is "Do not be too slow. Stay up-to-date on your patient's condition and use all tools possible to control the disease." Dr. Cobin also noted that all of the AACE recommendations including glucose tolerance testing for at-risk patients are covered under Medicare and most healthcare plans. Dr. Cobin urged primary care physicians to seek assistance from AACE to help code the test correctly for reimbursement purposes.

GlaxoSmithKline provided funding and other support to AACE for the report conducted by Surveillance Data Inc., and the national "State of Diabetes in America: Striving for Better Control" campaign.

AACE 14th Annual Meeting and Clinical Congress: Preconference Briefing. Presented May 18, 2005.

Reviewed by Gary D. Vogin, MD

Terry Hartnett is a freelance writer for Medscape.