Fact Check: Did ACP Really Say That HbA1c of 8.4% or PP 250 mg/dL Is Not Diabetes?

An Instagram reel claims that the “American College of Physicians (ACP) 2018 guideline has stated that an HbA1c of 8.4% or postprandial (PP) glucose of 250 mg/dL is not diabetes”. The claim is FALSE. The video further makes claims, "Cochrane recommends that a blood pressure reading of 160/100 is normal and that Cochrane is a government-funded organization". These claims are also FALSE.

Claim

In an Instagram reel, it is claimed that HbA1c 8.4% or PP Glucose 250 mg/dL Is Not Diabetes. The video also makes additional claims, including that Cochrane is a government-funded organization and that a blood pressure reading of 160/100 is considered normal.

In the reel by _vishal___saini_, it is said, "Alright, let’s start. How can we control diabetes through naturopathy — how can we reverse it? First, you have to escape a trap. There’s a trap of diagnosis. You’ll be surprised to know — there’s an organization called ACP — the American College of Physicians. I can provide you with evidence, I can even show you their publication. Remember the name ACP — American College of Physicians. This body is even more influential than the World Health Organization. They have a larger team of doctors. Their team is bigger than WHO’s.

In 2018, they released new diabetes guidelines. These guidelines never reached 99% of the people. What were those guidelines? They stated that if someone’s HbA1c is 8.4, that person is not diabetic. Broadly speaking, if someone’s postprandial glucose (i.e., 2 hours after eating) comes out to be 250, that’s not considered diabetic. This should make you happy. But within the medical fraternity, it created an uproar.

I was once stuck in Noida during a protest. I saw all the doctors standing there with black armbands saying “We won’t work! We won’t work!” Why? Because ACP had declared this guideline. Shouldn’t they be happy? This research was beneficial but not profitable. You get my point? They accepted it quietly, but they didn’t let the public know. Hardly anyone has heard of ACP or this research.

There is another organization — Cochrane. Spelled C-O-C-H-R-A-N-E. Cochrane Collaboration, Cochrane Library, Cochrane Database — all the same entity. They have offices in around 125–130 countries. They don’t hire anyone who has ever had any ties with a pharmaceutical company or any kind of vested interest. They only work with independent researchers, scientists, and doctors. In India, they have two offices — one in Delhi and one in Kolkata.

They are 100% government-funded. That means Cochrane is so influential that governments themselves fund their research. Just like the Indian government funds Cochrane India to conduct research. Cochrane has been saying for the past 25 years that diabetes is not diagnosed at postprandial 250. What ACP stated recently is something Cochrane has been saying for decades. Similarly, Cochrane also says that if your BP is 160/100, that does not make you a hypertensive patient.

They’ve even stopped surgeries for people because their BP was too high — but Cochrane has issued complete guidance that up to 160/100 is still acceptable. People think Japanese live the longest, but actually, Norwegians have the highest life expectancy. The normal BP for Norwegians is 150/90 — and their government considers that normal. If our Indian guidelines were applied there, 70% of Norway would be labelled hypertensive. So, first you have to understand and come out of these traps.

Now, who will you believe? One guideline says postprandial 140 is diabetes. Another says 250 is still not diabetes. Cochrane says 250. WHO and the United Nations have now recognized both ACP and Cochrane equally. So, if you’re a chemist running a shop, believe 140. But if you’re a patient, believe 250. First, get out of the trap and ask — who are you targeting? And in my opinion, numbers shouldn’t be the only factor. Whether it’s 140 or 250 — the real question is: how are you feeling?

I had a patient once whose glucose was 450. He came by motorbike and said, “Sir, I never feel unwell.” He had no symptoms of diabetes. So, like shoes — you might wear size 10, I wear size 8, someone else size 7. You can't fix one number for everyone. In 2003, overnight, one crore Indians became diabetic. Why? Because until 1997, we followed WHO guidelines.

WHO used to say fasting glucose of 123 is not diabetes. Then in 2003, India created three criteria — fasting became 100, PP 140. Then in 2010, HbA1c was added. So somewhere, you got trapped. India now has 9% diabetic population. Kuwait has 18%. Their rich population — you can see — they are making money by selling oils. In Kuwait, 50% of diabetic patients become blind in the last days of their life. Despite being oil-rich. So, the key point is: thresholds — who is defining them?

Did you have symptoms or not? You take one lab test, your glucose is 145 — and now you’re declared diabetic. Those who escape this trap and gain knowledge — they learn how to bring glucose back to normal without any disease, without any medicines."

The claim can be seen here.

Fact Check

The claims is FALSE. There is no scientific evidence or medical consensus supporting the user’s claim that the ACP has endorsed an HbA1c level of 8.4% or a postprandial glucose level of 250 mg/dL as standalone criteria for diagnosing diabetes or that the guidelines state that HbA1c level of 8.4% is not diabetes. The clinical guidelines published in 2018 by the Annals of Internal Medicine (ACP Journals) recommend maintaining HbA1c levels between 7% and 8% for most patients with type 2 diabetes, focusing on individualized care rather than fixed diagnostic thresholds beyond established standards.

The video also claims that the blood pressure was too high stating that Cochrane considers up to 160/100 as acceptable. This is FALSE. In reality, Cochrane recommends target blood pressure levels below 130/80 mmHg in general. The video further falsely claims that Cochrane is a government-funded organization, whereas in truth, Cochrane is an independent, global, non-profit entity.

Is HbA1c 8.4% or PP Glucose 250 mg/dL Not Diabetes?

Multiple international health organizations recognize both postprandial glucose and HbA1c as essential markers for diagnosing diabetes.

The World Health Organization recognizes both postprandial glucose and HbA1c as important indicators in the diagnosis and management of diabetes. Postprandial glucose, measured two hours after a meal, provides insight into how the body handles sugar after eating. A value of 200 mg/dL (11.1 mmol/L) or higher is typically used to diagnose diabetes. Likewise, Glycated Hemoglobin (HbA1c) reflects long-term blood sugar control over the past three months, and a level of 6.5% or above is considered diagnostic for diabetes.

According to the CDC, diabetes is diagnosed using specific blood test ranges: an HbA1c of 6.5% or higher indicates diabetes, 5.7%–6.4% indicates prediabetes, and below 5.7% is considered normal. A fasting plasma glucose level of 126 mg/dL or higher also confirms diabetes. For most people with diabetes, the recommended A1c goal is 7% or less to help prevent complications

Diabetes UK also states that an HbA1c level of 48 mmol/mol (6.5%) or above is used as the diagnostic threshold for diabetes. However, a result below this does not necessarily exclude diabetes if the diagnosis is made based on other glucose tests.

The American Diabetes Association recommends an A1C target of less than 7% (53 mmol/mol) for many nonpregnant adults. For certain individuals, a more stringent goal—such as below 6.5% (48 mmol/mol)—may be appropriate if it can be reached safely without causing significant hypoglycemia or other harmful side effects.

The American Diabetes Association further notes that in non-diabetic individuals, fasting plasma glucose levels typically range from 70 to 110 mg/dL after an 8–10 hour fast. Levels above this range may indicate impaired glucose regulation and, if persistently elevated ≥126 mg/dL, are used as a diagnostic criterion for diabetes.

A review published in JAMA Network states that diabetes is diagnosed when any of the following criteria are met: postprandial (fasting) glucose ≥126 mg/dL or HbA1c ≥6.5%.

Does ACP 2018 guideline state that HbA1c of 8.4% or postprandial (PP) glucose of 250 mg/dL is not diabetes?

No, the ACP has not stated in its 2018 guideline that an HbA1c of 8.4% or postprandial glucose of 250 mg/dL does not indicate diabetes. This claim is FALSE. Both values are well above diagnostic thresholds established by leading medical authorities such as the American Diabetes Association (ADA), CDC, Diabetes UK and the World Health Organization (WHO). Moreover, there is neither scientific evidence nor medical consensus supporting the claim, nor any proof that the American College of Physicians stated that an individual with an HbA1c of 8.4 or PP glucose of 250 mg/dl is not diabetic.

Further research by the Medical Dialogues Fact Check Team found that clinical guidelines published in 2018 by the American College of Physicians (ACP) Journals recommend an HbA1c target of 7% to 8% for most individuals with type 2 diabetes. These guidelines do not consider an HbA1c of 8.4% or a postprandial glucose level of 250 mg/dL alone as sufficient for diagnosing diabetes. The Guidance statements released in 2018 are as follows:

"Guidance Statement 1:

Clinicians should personalize 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.

Guidance Statement 2:

Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.

Guidance Statement 3:

Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%.

Guidance Statement 4:

Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population."

Hence, it can be concluded that both an HbA1c ≥6.5% and PP glucose ≥200 mg/dL are diagnostic of diabetes. An HbA1c of 8.4% or PP glucose of 250 mg/dL strongly indicates uncontrolled diabetes.

Does Cochrane consider a blood pressure of up to 160/100 mmHg as acceptable?

No, Cochrane has not stated that a blood pressure of up to 160/100 mmHg is considered normal or acceptable. This claim is FALSE. Moreover, major health authorities like the World Health Organization (WHO) and the American Heart Association clearly define 120/80 mmHg as the standard for normal blood pressure.

A Cochrane systematic review clarifies that current clinical guidelines recommend target blood pressure levels ranging from below 130/80 mmHg to below 150/90 mmHg, depending on individual risk factors. In the case of adults aged 80 years or older, some guidelines advise starting treatment only when systolic blood pressure exceeds 160 mmHg, but this is based on specific age-related risk–benefit assessments not because 160/100 is regarded as a normal or acceptable level for the general population.

The World Health Organization states that optimal systolic blood pressure measured when the heart contracts should range between 115 and 120 mmHg. The diastolic pressure recorded when the heart is at rest should ideally be between 75 and 80 mmHg. Blood pressure is considered elevated or high when the systolic value is 140 mmHg or more and/or the diastolic value is 90 mmHg or more.

Further, the American Heart Association provides clear guidelines on healthy and unhealthy blood pressure levels across all age groups. According to its classification, normal blood pressure is defined as less than 120/80 mmHg. Readings between 120–129 systolic and less than 80 diastolic are considered elevated.

Therefore, this claim is FALSE and lacks support from medical consensus or scientific research.

Is Cochrane a government-funded organization?

No, Cochrane is not a government-funded organization. Cochrane is a global, independent, non-profit network made up of health professionals, researchers, patients, and caregivers. It is dedicated to producing and promoting reliable, high-quality health information aimed at improving healthcare and health outcomes worldwide.

Hence, the claim in the video is entirely FALSE.

Medical Dialogues Final Take

The assertion that American College of Physicians (ACP) 2018 guideline has stated that an HbA1c 8.4% or postprandial glucose of 250 mg/dL is not indicative of diabetes is FALSE. According to the ADA, CDC, WHO, and Diabetes UK, diabetes is diagnosed at HbA1c ≥6.5% or postprandial glucose ≥200 mg/dL. The ACP guidelines also recommend an HbA1c target of 7–8% for treatment. However, they do not set diagnostic criteria, nor do they state that HbA1c of 8.4% or PP glucose of 250 mg/dL is not diagnostic of diabetes. The video further falsely claims that a blood pressure reading of 160/100 mmHg is considered acceptable by Cochrane, which is incorrect. Cochrane generally advises maintaining blood pressure levels below 130/80 mmHg. It also falsely asserts that Cochrane is a government-funded organization, whereas Cochrane is, in fact, an independent, global, non-profit network dedicated to producing reliable health information. Further, there is no scientific evidence or medical consensus supporting the user's multiple claims.

Hence, the user's claims are FALSE.