From the Guidelines
Recommended A1C goals for diabetic patients vary by age and health status, with a general target of less than 7.0% for most adults, but less stringent goals for older adults or those with multiple comorbidities. For most adults with diabetes, the general target is less than 7.0% 1. However, for younger and healthier patients without significant cardiovascular disease, a stricter goal of less than 6.5% may be appropriate if it can be achieved without significant hypoglycemia. For older adults (typically over 65) or those with multiple comorbidities, limited life expectancy, or history of severe hypoglycemia, less stringent goals of 7.5-8.0% or even up to 8.5% are recommended 1. These age-based targets reflect a balance between preventing long-term complications of hyperglycemia and avoiding the immediate risks of hypoglycemia. Younger patients have more years ahead to develop complications from sustained hyperglycemia, justifying tighter control, while older patients face greater risks from hypoglycemic episodes including falls, cognitive impairment, and cardiovascular events. Treatment intensity should be adjusted accordingly, with medication choices that minimize hypoglycemia risk in vulnerable populations. Regular A1C testing every 3-6 months allows for timely adjustments to maintain appropriate targets. Some key considerations for individualizing A1C goals include:
- Life expectancy
- Presence of microvascular and macrovascular complications
- Risk for adverse events related to glucose control
- Patient preferences
- Ability to manage the treatment regimen
- Comorbid conditions
- History of severe hypoglycemia
- Limited life expectancy
- Advanced microvascular or macrovascular complications
- Extensive comorbid conditions
- Long-standing diabetes in whom the goal is difficult to attain despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin 1.
From the Research
A1C Goals Based on Age
The recommended A1C goals for diabetic patients can vary based on age and other factors.
- For older adults, the American Diabetes Association (ADA) recommends different A1C targets based on comorbid health status 2.
- A study published in 2021 found that older adults with A1C <7% were not at elevated risk of mortality or hospitalizations, regardless of health status 2.
- The ADA recommends an A1C target of less than 7% for many nonpregnant adults, and considers a target of 6.5% if it can be achieved safely 3.
- However, the American College of Physicians (ACP) proposes a target range of 7% to 8% for most patients with type 2 diabetes 3.
- For younger patients, the goal is often to achieve an A1C level as close to normal as possible, typically less than 7% 4, 5.
- A study published in 2020 found that 86% of patients with type 2 diabetes achieved an A1C target of ≤7.0% using an individualized approach to treatment 6.
Factors Influencing A1C Goals
Several factors can influence the recommended A1C goals for diabetic patients, including:
- Age: older adults may have different A1C targets based on comorbid health status 2.
- Comorbid health status: patients with complex or poor health status may have different A1C targets 2.
- Life expectancy: patients with a life expectancy of less than 10 years may not require A1C-targeted treatment 3.
- Treatment approach: an individualized approach to treatment, including the use of certain medications, may help patients achieve their A1C goals 6.