From the Guidelines
For BJ, an 82-year-old newly diagnosed with diabetes who is a healthy older adult with an A1C of 8.3%, I recommend an A1C goal of < 7 to 7.5%. This recommendation is based on the most recent guidelines from the American Diabetes Association Standards of Care, as outlined in the 2025 standards of care in diabetes 1. According to these guidelines, healthy older adults with few chronic illnesses and intact cognitive and functional status can aim for an A1C goal of < 7.0–7.5%. This target range balances the need for glycemic control with the risk of hypoglycemia and other treatment-related adverse effects that could impact quality of life or independence.
The guidelines suggest that this target range is appropriate for healthy older adults because they can generally perform complex tasks to maintain good glycemic control when their health is stable 1. However, it is also important to consider the potential risks of hypoglycemia, particularly during acute illness, and to adjust the treatment plan accordingly.
In contrast to the 2021 standards of care in diabetes 1, the 2025 guidelines provide more specific guidance on the management of diabetes in healthy older adults. The 2025 guidelines emphasize the importance of individualizing treatment goals and considering the patient's overall health status, cognitive function, and ability to manage their diabetes regimen.
Overall, the recommended A1C goal of < 7 to 7.5% for BJ is consistent with the most recent guidelines and takes into account their health status as a healthy older adult. This target range will help reduce the risk of diabetes complications while minimizing the potential for treatment-related adverse effects.
Key considerations in determining this target range include:
- BJ's health status as a healthy older adult with few chronic illnesses and intact cognitive and functional status
- The risk of hypoglycemia and other treatment-related adverse effects
- The importance of individualizing treatment goals and considering the patient's overall health status and ability to manage their diabetes regimen
- The guidance provided by the 2025 American Diabetes Association Standards of Care 1
From the Research
A1C Goal for BJ
Based on the provided evidence, the recommended A1C goal for BJ, an 82-year-old healthy older adult with a newly diagnosed A1C of 8.3%, can be determined as follows:
- The 2021 American Diabetes Association (ADA) guidelines recommend different A1C targets in older adults based on comorbid health status 2.
- For healthy older adults, the ADA guidelines suggest an A1C target of <7% to <7.5% or <8% depending on the individual's health status and risk of hypoglycemia 2.
- Considering BJ's healthy status and newly diagnosed diabetes, a reasonable A1C goal would be <7% to <7.5% or 7 to <8% 2.
- However, the exact A1C goal should be individualized based on BJ's specific health status, risk of hypoglycemia, and other factors 3.
- It is essential to note that lifestyle modification, including dietary changes and physical activity, can help achieve target glycemia in patients with type 2 diabetes mellitus 4, 5.
Key Considerations
- BJ's age and health status should be taken into account when determining the A1C goal 2, 3.
- The risk of hypoglycemia and other adverse effects should be considered when setting the A1C goal 3.
- Lifestyle modification and glucose-lowering medication use should be tailored to BJ's individual needs and health status 4, 5.