From the Guidelines
The A1c goal for a geriatric patient should be individualized, with a target range of 7.5% to 8.5%, considering the patient's health status, cognitive function, and functional status. This recommendation is based on the most recent and highest quality study, which provides a framework for considering treatment goals for glycemia in older adults with diabetes 1. The study suggests that for healthy older adults with few coexisting chronic illnesses, a reasonable A1C goal is 7.5%, while for those with complex or intermediate health status, a goal of 8.0% may be more appropriate. For very complex or poor health status, a goal of 8.5% may be considered.
When determining the A1c goal for a geriatric patient, several factors should be taken into account, including:
- Health status: Patients with multiple coexisting chronic illnesses or mild-to-moderate cognitive impairment may require a higher A1c target.
- Cognitive function: Patients with cognitive impairment may require a higher A1c target due to the increased risk of hypoglycemia.
- Functional status: Patients with limited functional status may require a higher A1c target due to the increased risk of hypoglycemia.
- Support systems: Patients with adequate support systems may be able to achieve tighter glycemic control, while those without support systems may require a higher A1c target.
It is essential to balance the long-term benefits of tight glycemic control against the immediate risks of hypoglycemia, which can lead to falls, confusion, and hospitalization in older adults. Treatment decisions should consider the patient's overall health status, cognitive function, support systems, and personal preferences rather than focusing solely on numerical targets 1.
In terms of specific A1c targets, the study suggests the following:
- Healthy older adults: 7.5%
- Complex or intermediate health status: 8.0%
- Very complex or poor health status: 8.5%
These targets are based on the most recent and highest quality evidence available 1, and should be used as a guide for determining the A1c goal for geriatric patients.
From the Research
A1c Goal for Geriatric Patients
The American Diabetes Association recommends achieving an A1c level of 7% or lower for geriatric patients with diabetes 2. However, this goal may need to be individualized based on the patient's health status, life expectancy, and risk of hypoglycemia.
Factors to Consider
- The patient's comorbid health status, with healthier patients potentially benefiting from tighter glycemic control and those with more complex health issues potentially requiring less stringent targets 3
- The risk of hypoglycemia, which may be higher in older adults and may not be directly related to A1c levels 4
- The use of glucose-lowering medications, which can impact the risk of hypoglycemia and the achievement of A1c targets 5, 6
A1c Targets
- For healthy older adults, an A1c target of <7% may be reasonable 3
- For those with complex or intermediate health status, an A1c target of <8% may be more appropriate 3
- For those with very complex or poor health status, an A1c target of <8% may still be beneficial, but the risk of hypoglycemia must be carefully considered 3, 4
Key Points
- Geriatric patients with diabetes require individualized A1c targets based on their health status and risk of hypoglycemia
- The American Diabetes Association recommends achieving an A1c level of 7% or lower, but this goal may need to be adjusted for older adults with complex health issues
- The use of glucose-lowering medications and the risk of hypoglycemia must be carefully considered when determining A1c targets for geriatric patients 2, 3, 4, 5, 6