Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement From the American Diabetes Association and the European Association for the Study of Diabetes

Drs. Jellinger, Lebovitz, and Davidson (1) take issue with three features of the consensus algorithm (2). First, they protest that the “therapeutic target A1C of 7%” will miss the opportunity to reduce complications, including microvascular and cardiovascular disease, as much as lower A1C targets that are “achievable safely”. Second, they suggest that the consensus algorithm ignores the importance of achieving postprandial glucose control, and third, that the algorithm ignores the “heterogeneity of the pathogenesis of phenotypic type 2 diabetes.” They further note a “philosophical problem” in our “rejection of newer, well-proven treatments because they lack multiyear clinical trials.” The American College of Endocrinology/American Association of Clinical Endocrinologists (ACE/AACE) response is disappointing in the failure to read the algorithm carefully and in its reliance on observational and epidemiologic data and analyses rather than on the clinical trial data that are universally …