#96 Diabetes: A1C targets & ACP guidelines controversy

Get schooled on hemoglobin a1c targets in type 2 diabetes mellitus by American College of Physicians guidelines coauthor, Devan Kansagara MD MCR, Associate Professor of Medicine, Oregon Health Sciences University. We summarize outcomes from the landmark diabetes trials (ACCORD, ADVANCE, VADT, UKPDS 33 & 34), how a1c targets effect microvascular and macrovascular events, estimating life expectancy, and how to personalize diabetes control for your patients. We’re proud to announce our new partnership with the ACP to provide free CME credit and MOC points on select episodes of The Curbsiders. ACP members can visit acponline.org to redeem free CME/MOC credit.

Full show notes available at http://thecurbsiders.com/podcast

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Credits:

• Written, produced, and edited by: Matthew Watto MD.
• Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD.
• Guest: Devan Kansagara MD, MCR

Time Stamps

• 00:00 Announcement
• 00:48 Disclaimer and intro
• 03:11 Getting to know our guest: one liner, book recommendation, mentorship
• 06:50 How and why did ACP write their guidance statement on diabetes, A1C targets
• 09:18 Landmark trials in type 2 diabetes
• 11:36 Does tight control prevent micro or macrovascular complications
• 13:20 Trials of newer agents like SGLT2i, GLP-1 and DPP4i
• 14:33 How do ACP’s guidelines differ from other published guidelines
• 17:20 Quick recap of landmark trial findings
• 22:24 Personalizing glycemic control
• 24:30 Controversy over an A1C goal of 7-8%
• 28:05 Clinical inertia
• 30:26 Legacy effect and metabolic memory
• 34:00 Deintensifying therapy
• 38:29 Life expectancy and comorbid conditions
• 43:15 Performance measures in diabetes
• 44:42 Take-home points
• 46:30 The Curbsiders recap and give some closing remarks
• 49:13 Outro