HbA1c targets debated, history of SGLT-2 inhibitors explained
Experts offered differing recommendations for a patient's HbA1c target in Beyond the Guidelines, while a History of Medicine article said that the risks of sodium-glucose cotransporter-2 (SGLT-2) inhibitors could have been understood sooner.
The debate over HbA1c targets and the risks of sodium-glucose cotransporter-2 (SGLT-2) inhibitors were analyzed in recent Annals of Internal Medicine features.
In a Beyond the Guidelines feature published Oct. 1, a diabetologist and a general internist discussed how guidelines from ACP and the American Diabetes Association differ on the recommended HbA1c target for a patient with long-standing type 2 diabetes and a current HbA1c level of 7.8%. The experts debated three key questions—the risks and benefits of aiming for tight glucose control, what HbA1c level to target and to how achieve it, and when to deintensify HbA1c goals. The feature, which includes print, video, and educational components, was based on a Grand Rounds conference held April 13 at Internal Medicine Meeting 2019 in Philadelphia.
A History of Medicine article, published Sept. 17, looked at how lack of historical awareness delayed recognition of the risk of ketoacidosis with SGLT-2 inhibitors until more than two years after FDA approval. Contemporary SGLT-2 inhibitors are derived from the phytochemical phlorizin, which was studied as a treatment for diabetes as early as the 19th century and was reported to be associated with ketosis in 1914. “Neither government regulators nor manufacturers of SGLT2 inhibitors evinced an awareness of this extensive historical record. The absence of historical inquiry delayed notice of ketoacidosis as an adverse reaction, which could have reduced the burden of illness from these drugs,” the article explained.