In Reply: We agree with Dr Skolnik that the ADA clinical practice recommendations state the need to carefully consider multiple criteria in deciding which patients should be considered for less stringent targets. We note, however, that the guidelines start out with the assumption of a hemoglobin A1c goal of less than 7% level “in general.” From our perspective, this term does not sufficiently emphasize individualized targets based on the balance of benefits and harms of treatment. Cross-sectional population-weighted analyses indicate that in 1999 to 2002 about 45% of US residents with diabetes self-rated their health as fair or poor; 38% were 65 years of age or older; and 24% were taking 7 or more medications.1
Pogach L, Aron D. Guidelines for Glycemic Control and Individualized Targets—Reply. JAMA. 2010;304(10):1069–1070. doi:10.1001/jama.2010.1258
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