The American College of Physicians has issued updated guidance on the use of haemoglobin-A1c (HbA1c) levels in monitoring glycaemic control of patients with type 2 diabetes.
It is accepted that good glycaemic control is necessary in diabetes and if achieved will significantly reduce the likelihood of adverse complications. HbA1c is widely used as a means of monitoring diabetic control, and this paper is intended to summarise the evidence base for monitoring and for suitable HbA1c levels in particular. As there are already many guidelines available on this topic, the College considered that it was appropriate to provide a rigorous review of suitable existing guidelines rather than produce a new guideline from first principles.
A comprehensive search strategy was used to locate guidelines that included discussion of diabetic control. Eligibility was restricted to English language because of the difficulties in translating non-English documents, and only most recent updates were used. Eligible guidelines were assessed using the Appraisal of Guidelines, Research and Evaluation in Europe (AGREE) collaboration method to get an assessment of guideline quality. Recommendations on glycaemic control were extracted from high quality guidelines and used to synthesise overall recommendations.
Nine sets of guidelines were accepted as being of sufficient quality and included specific recommendations on control. Based on these, the authors recommend the following (taken directly from the article summary with Anglicisation of spellings):
The authors comment that there are still challenges in understanding the benefits and harms of particular levels of control, especially in complex patients, and further research would be valuable. Attention should also be paid to control of blood pressure and lipid levels.