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Dr. Jeffrey Mechanick Part 8, Joint A1C Recommendations

Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 8 of this Exclusive Interview, Dr. Mechanick explains the comprehensive focus of the AACE A1C guidelines.

Dr. Jeffrey Mechanick, MD, FACP, FACE, FNLA is the Clinical Professor of Medicine and Director of Metabolic Support in the Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai, NY. Dr. Mechanick was chosen president of the American College of Endocrinology (ACE) in May 2016, an office he will hold for one year. His current research interests are in nutrition and metabolic support, lifestyle and obesity medicine, and network analysis of complex systems.

Transcript of this video segment:

Steve Freed: One of my favorite questions to ask somebody from AACE organization is, I’ve always learned that according to the ADA, recommended A1C, and I know it’s all individualized, but in general the recommended A1C for the American Diabetes Association is 7 and below. You know as well as I do that AACE says 6.5 or below. I know where these come from, they come from clinical studies showing directly when the first problems with diabetes appear. When I tell people that, I say why can’t these two organizations get together and come up with one number? Because some doctors will treat according to ADA and some doctors will treat according to AACE. Why is there this difference and why can’t we come up with one single number?

Dr. Mechanick: So first of all, it’s not so concretely different anymore. You’re absolutely right that at the beginning AACE firmly had this target of 6.5 which was probably more evidenced based than 7.0. But again it depends on which evidence base you are looking at and how you prioritize your methodologies. But that isn’t the case now. In 2011, with Dr. Handelsman chairing the writing committee for the guidelines, we actually extended the upper limit as high as 8.0 and that was repeated in our most recent guidelines. The reason is precisely for what the commentary was, that in some patients it was too risky and obviously based on a chord in some other studies, too risky to keep layering on more and more medication. So our guidelines do allow that latitude, depending on the individualization, personalization of comprehensive diabetes care. Just to summarize, the answer’s in two parts. First we do explicitly provide a range that in the ideal world, yes, 6.5, but we do allow a higher upper limit. Second, to bear in mind that the nature of AACE guidelines, compared to other guidelines, is the comprehensive focus, that although glycemic control is very important, it is not the only important target. A1C is not the only important target. And that if you inject that algorithm for just glycemic control, in a basin of all of the problems that someone with diabetes has or could have in a preventive care paradigm, then you understand what AACE guidelines are about. You understand that yes it’s about glycemic control, but it’s also about lifestyle, nutrition, physical activity, hypertension treatment and prevention, dyslipidemia treatment and prevention, vascular biology and all of the other hosts of complications.

To view other segments in this video series:

Part 1: Nutrition and Lifestyle
Part 2: Effective Diet Discussions
Part 3: Simplifying Aspects of Diabetes Care
Part 4: Influx of Prediabetes Patients
Part 5: Tips to Alter Lifestyle
Part 6: Bariatric Surgery and Obesity Treatment
Part 7: Government Assistance