The 2018 update of the American College of Physicians glycaemic management recommendations: An invitation to continued inertia?

The management of type 2 diabetes has become increasingly controversial. Tight control has been advocated for years; however, there was a recent revision published by the American College of Physicians in which limitations were made to liberalize glycaemic goals for most diabetics, targeting a level between 7% and 8%. In recent years, the evolution of diabetes care has been such that more potent drugs, with low risk of hypoglycaemia when used in the absence of insulin or secretagogues, have made their way into the market place. Use of such agents has made it easier to achieve greater glycaemic control reasonably safely. Unfortunately, it appears that there has been a significant amount of inertia over the past decade, which continues to persist. Relaxing the glycaemic control targets, as recommended by the American College of Physicians, may only help to propagate this inertia.