In part 3 of this Exclusive Interview, Dr. Yehuda Handelsman talks with Diabetes in Control Publisher Steve Freed during the AACE 2018 convention in Boston, MA about why the ACP changed A1C guidelines to 7% in their 2018 recommendations, and why he believes the new guideline is influenced by outdated research.
Yehuda Handelsman, MD, FACP, FNLA, MACE is a past president of the American College of Endocrinology and Medical Director of the Metabolic Institute of America in Tarzana, CA.
Transcript of this video segment:
Freed: Well, recently ACP, the American College of Physicians, came out with their own guidelines that said A1Cs should be 7-8 percent and that, that is O.K. Where did that come from?
Handelsman: You know it’s a good question. I am a member of ACP (American College of Physicians) and they know that I am an endocrinologist. In fact, many of my colleagues are not only members of ACP but ACP have been utilizing them to teach diabetes. Yet, they did not contact any of us. They did not really develop a correct guideline. This is really a travesty to a point. What they did, they took 5-6 guidelines AACE, ADA, and others and said that when they look at those guidelines, they are not convinced that what is being said is correct, and therefore, they are O.K. with 7-8 [A1C] because there were studies that when you treated the patients to goals at less than 7 there were hypoglycemia and death and we do not want that; 7-8 is O.K. They were not convinced. But, did the [ACP] look at the studies of the last 5-8 years? They said they did not. So, we looked at them and asked them if they were regressive or something. We do not want to treat to hypoglycemia; we say, we treat safely. It’s not just the goal, it’s how you get there. When you get there by causing hypoglycemia, yes say higher, but then your patients will die from other complications, or will have retinopathy, or will have more kidney disease. I mean, that’s not important? Well, you know, many of my patients wouldn’t mind an MI that maybe won’t see as much with an A1C of 7.7 but definitely will see a lot of blindness with that. So, this is kind of very regressive, they are not the true guidelines. It’s a reflection on our guideline. I was interviewed about that and I got an email from England by very well-known epidemiologist in the field of diabetes and in practice. He said, “Dr. Handelsman, why are you so against the ACP? What we do in England is very similar and we have great results and we show that if we don’t go below 7, mortality will increase.” Then he showed me all the studies that he based on it. All of them were done with either Sulfonylurea or older types of insulin with a lot of hypoglycemia just underscoring what we are saying – when we are using the newer drugs we can get people not just to reduce heart disease like we saw with empagliflozin or with liraglutide, but we know that they are very safe. I can take a person with an A1C of 10, I give them triple therapy with a once-a-week GLP-1 and a once-a-day combination of metformin/SGLT2 and I will get them to 6.5 A1C with no side effects for 75 percent of them. I’ve got them to go and I’ve got no issues with them – they won’t get hypoglycemia and who knows now, based on the studies, maybe they’ll get very good cardiovascular benefit, they’ll lose some weight, they’ll get their blood pressure better. I do not think we should be blind to new science. Sometimes ignorance is bliss and sadly enough, that is what graced the ACP with their new guidelines.
Freed: Maybe we should put that combination into my drinking water.
Handelsman: Well, no, only if you have diabetes and you are not controlled.