From the Guidelines
For an 80-year-old patient, the goal A1c should be individualized, focusing on minimizing symptoms related to hyperglycemia, and avoiding targeting a specific HbA1c level, as the harms of tight glycemic control may outweigh the benefits in this population. According to the American College of Physicians guidance statement 1, 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). This approach prioritizes the patient's quality of life and reduces the risk of hypoglycemia and other adverse effects associated with intensive glycemic control.
Some key points to consider in managing an 80-year-old patient with type 2 diabetes include:
- Focusing on avoiding hypoglycemia and hyperglycemic symptoms rather than preventing long-term complications
- Prioritizing medication safety, with metformin often remaining first-line if kidney function is adequate
- Considering agents with low hypoglycemia risk, such as DPP-4 inhibitors or GLP-1 receptor agonists, over sulfonylureas or insulin
- Using simpler regimens with basal insulin when insulin is necessary, rather than multiple daily injections
- Regular blood glucose monitoring, especially if the patient is on insulin or sulfonylureas
This individualized approach balances quality of life with glycemic control, recognizing that avoiding hypoglycemia and its associated risks is particularly important in elderly patients with diabetes 1.
From the Research
Goal A1c in 80-year-old
- The American Diabetes Association (ADA) guidelines recommend different A1C targets in older adults based on comorbid health status 2.
- For older adults with diabetes, an A1C target of <7% is considered reasonable, especially for those who are healthy or have complex/intermediate health status 2.
- However, for those with very complex/poor health status, an A1C target of <8% may be more appropriate to avoid increased risk of mortality and hospitalizations 2.
- The choice of glucose-lowering medication, such as sulfonylureas, dipeptidyl peptidase-4 inhibitors, or thiazolidinediones, does not significantly impact the achievement of A1C targets in older adults with type 2 diabetes 3.
- Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to be effective in lowering HbA1c and reducing body weight in patients with type 2 diabetes, with some GLP-1RAs having a more favorable safety profile than others 4.
Considerations for Older Adults
- Older adults with diabetes should be assessed individually to determine the most appropriate A1C target based on their health status and comorbidities 2.
- The use of glucose-lowering medications should be carefully considered in older adults, taking into account their potential benefits and risks, as well as the individual's overall health status and quality of life 5, 3.
- GLP-1RAs may be a suitable option for older adults with type 2 diabetes who require additional glucose-lowering therapy, due to their efficacy and safety profile 4.