The Curbsiders Internal Medicine Podcast

#96 Diabetes: A1C targets & ACP guidelines controversy

May 21, 2018

49:40

Diabetes Type 1 Diabetes Type 2 Weight Management

Episode Description

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