From the Guidelines
A1C testing should not be stopped based on age alone, and it is recommended to continue testing throughout life for patients with diabetes, as it remains a crucial tool for monitoring glucose control and guiding treatment decisions. The decision to modify or potentially stop A1C testing should be individualized based on the patient's overall health status, risk of hypoglycemia, and goals of care, rather than age alone 1. For older adults with diabetes, especially those with limited life expectancy, multiple comorbidities, or cognitive impairment, less stringent A1C goals may be appropriate, such as 7.5-8.5%, rather than discontinuing testing altogether.
Key Considerations
- A1C testing provides valuable information about glucose control over the previous 2-3 months and helps guide treatment decisions to prevent diabetes complications, which remain relevant even in advanced age 1.
- The frequency of testing may be reduced from the standard recommendation of twice yearly for stable patients and quarterly for those with therapy changes or not meeting goals 1.
- In patients receiving palliative or end-of-life care, the focus typically shifts to symptom management and quality of life rather than long-term diabetes control, and A1C testing may become less relevant in these circumstances.
- The American Diabetes Association recommends that A1C testing be performed routinely in all people with diabetes at initial assessment and as part of continuing care, with measurement approximately every 3 months to determine whether glycemic goals have been reached and maintained 1.
Individualized Approach
The approach to A1C testing should be individualized, taking into account the patient's specific needs, health status, and goals of care. This may involve adjusting the frequency of testing or setting less stringent A1C goals for older adults or those with limited life expectancy. Ultimately, the decision to continue or modify A1C testing should be based on a comprehensive assessment of the patient's overall health and well-being, rather than age alone 1.
From the Research
Age to Stop A1c Testing
There is no specific age mentioned in the provided studies to stop A1c testing.
- The studies focus on the performance of HbA1c in detecting prediabetes and diabetes compared to other tests like fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) 2, 3, 4.
- They discuss the accuracy and reliability of HbA1c in different populations, including those with tuberculosis 4 and its comparison with other diagnostic criteria 5, 6.
- However, none of the studies provide information on when to stop A1c testing based on age.
- It is essential to note that A1c testing is a crucial tool for managing and monitoring diabetes, and the decision to stop testing should be based on individual patient needs and medical guidelines, rather than age alone 2, 3, 4, 5, 6.
Key Findings
- HbA1c has comparable performance to FPG and is better than OGTT in classifying subjects with diabetes 2.
- The best cut-off points for HbA1c were found for discriminating between normal and prediabetes groups and between prediabetes and diabetes groups 3.
- HbA1c may be a more reliable test in individuals with transient hyperglycaemia 4.
- The 1-h PG level during OGTT could increase the likelihood of identifying high-risk individuals 5, 6.