In the Sunday series, we bring to you an article from our archives' most read section, in which Dr. V Mohan provides his response to the recent American College of Physicians Guidelines on diabetes which has generated a fair deal of interest and controversy in the field of diabetes.

It is true that in some patients with type 2 diabetes, one should aim for a less stringent control and an A1c between 7 and 8% would be acceptable. However, there is no one size fits all. In the case of a young patient with fairly short duration of diabetes, one can definitely achieve a much tighter target and we can aim for A1c even as low as 6% without any serious risk of hypoglycemia or other side effects.

As the duration of diabetes gets longer and the age of the patient increases, if patients are frail or they have complications of diabetes like nephropathy, it is better not to aim for very tight control. In most cases, an A1c of 7% may be achievable but there are a definite subset of patients in whom the A1c level should be between 7 and 8% or in some cases even higher.

The simplest answer to a question like this would be that we have to individualize our treatment. This is what Personalized Diabetes is all about. While ‘Guidelines’ are useful in a general sense that is literally what they are i.e. general ‘guidelines’.

Each patient is different and the principle to follow is to obtain the best possible control as assessed by A1c as is possible in that particular patient, at that particular point of time, without any risk of adverse events. This HbA1c value can vary from 6% in some people to 8% or even higher in others. As long as we individualize our treatment, this should be fine.

One of the interesting and amusing (and a one way worrisome) off shoot of this is the effect that this had on the public. Whatsapp messages have been going a round like crazy saying that the ‘HbA1c should be between 7 and 8 and all those who have lower values say 7% or lower should try to increase their sugar levels’. At one of the parties that I attended recently, a patient of mine came to me and said he was intentionally eating sweets As it is now decided that A1c of 8% must be maintained.

These are the kind of disastrous consequences that can result, if such matters are discussed in public platforms rather than in scientific fora. Again, there are whatsapp messages going round that the American College of Physicians has said that plasma glucose levels upto 250 mg/dl are normal and that one does not have diabetes if glucose levels are below 250 mg/dl.

The ACP guidelines have never mentioned anything like this but the facts get twisted by people especially on social media. Hence, as far as possible, in practice, doctors should continue to do what they have been practicing all along and not be influenced by these guidelines which keep changing every now and then, like the weather.

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