As per the new guidelines from ACP, clinicians should personalise goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care. The guidelines recommend clinicians should also aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes - as against the traditional 6.5 to 7% which has been followed over decades. Generally, a hba1c of 6.5% indicates diabetes.
The doctors here advise that the controversial guideline of relaxing blood glucose target should not be applied in the country because diabetes in India is more aggressive, and binding to this new norm can have serious impacts on patients. India has its own three advisory bodies - the ICMR (Indian Council of Medical Research), RSDDI (Research Society For The Study of Diabetes in India) and API (Association of Physicians of India).
“In reality, Indian physicians continue to follow US-based guidelines, hence ACP guidelines may have a substantial impact in India. If blood sugar control is loosened (as advised by ACP), more patients in India will suffer from complications, the burden of which is already high. We should ignore these, and stick to previous time-tested glycosylated haemoglobin limit of control of 7%,” Anoop Misra, chairman of Delhi-based Fortis-C-DOC (Centre of Excellence For Diabetes, Metabolic Diseases and Endocrinology), was quoted as saying by TOI.
Others concur the guidelines cannot be standardised because of several differences in lifestyle, physiology and food habits.
The World Health Organisation (WHO) estimates that India has about 70 million diabetics and is rapidly moving towards becoming the diabetes capital of the world, even though rates of the disease are increasing across the world. Also, a study done by the International Diabetes Federation has warned that by 2030, nearly 9% of India’s population will be affected by diabetes if the present trends continue.
Meanwhile, ACP’s new guidelines on diabetes published in the Annals of Internal Medicine have also drew flak from the American Diabetes Association who said the new guidance does not consider the positive legacy effects of intensive blood glucose control confirmed in multiple clinical trials and, therefore, are not reflective of the long-term benefits of lower A1C targets.