From the Guidelines
Yes, A1c levels tend to increase slightly with age, even in individuals without diabetes, primarily due to changes in glucose metabolism, decreased insulin sensitivity, and reduced pancreatic beta cell function that occur as part of normal aging 1. For every decade of life, A1c may increase by approximately 0.1%. This age-related increase is generally not a major concern if the values remain within or slightly above the normal range (below 5.7%). However, if A1c levels rise significantly with age (6.5% or higher), this indicates diabetes and requires medical attention. The distinction between normal age-related increases and pathological elevations is important. For older adults without diabetes, maintaining regular check-ups is sufficient, while those with borderline values (5.7-6.4%) should focus on lifestyle modifications including regular physical activity, maintaining a healthy weight, and following a balanced diet. Age alone doesn't necessitate treatment for mildly elevated A1c, but it's essential to consider other cardiovascular risk factors when evaluating overall health status in older individuals, as emphasized by the American College of Physicians guidance statement on HbA1c targets for glycemic control with pharmacologic therapy in nonpregnant adults with type 2 diabetes mellitus 1. Some key points to consider include:
- The American College of Physicians recommends personalizing goals for glycemic control in patients with type 2 diabetes based on a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care 1.
- Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes, as this range is associated with a balance of benefits and harms 1.
- For patients with a life expectancy less than 10 years due to advanced age, residence in a nursing home, or chronic conditions, the focus should be on minimizing symptoms related to hyperglycemia rather than targeting a specific HbA1c level, as the harms of intensive glycemic control may outweigh the benefits in this population 1. It is crucial to weigh the benefits and harms of glycemic control in older adults, considering factors such as life expectancy, comorbid conditions, and risk for hypoglycemia, to provide personalized care that prioritizes quality of life and minimizes adverse effects 1.
From the Research
A1c and Age
- There is no direct evidence in the provided studies that A1c levels increase with age 2, 3, 4, 5, 6.
- The studies focus on the effects of different medications on A1c levels in patients with type 2 diabetes, but do not examine the relationship between A1c and age.
Causes of Increased A1c
- The studies suggest that inadequate glycemic control, as measured by A1c levels, can be due to various factors, including the type and dosage of medication, patient compliance, and individual responses to treatment 2, 3, 4, 5, 6.
- For example, the addition of pioglitazone to sulfonylurea and metformin combination therapy was shown to improve A1c levels in some patients 2, while the use of insulin glargine as add-on therapy to sulfonylurea or metformin resulted in greater reductions in A1c levels compared to pioglitazone 3.
Concerns Related to A1c
- Elevated A1c levels are a concern in patients with type 2 diabetes, as they indicate poor glycemic control and increased risk of complications such as cardiovascular disease, nephropathy, and retinopathy 2, 3, 4, 5, 6.
- The studies highlight the importance of achieving and maintaining good glycemic control, as measured by A1c levels, through the use of effective medications and treatment regimens 2, 3, 4, 5, 6.