From the Guidelines
A reasonable A1C target for a 70-year-old patient with diabetes is less than 7.5-8.0%, individualized based on the patient's overall health status, as recommended by the 2021 standards of medical care in diabetes 1. When determining the appropriate A1C target, it's crucial to consider the patient's health status, cognitive function, and ability to manage their diabetes regimen.
- For a relatively healthy 70-year-old with few comorbidities and good functional status, a target closer to 7.0% may be appropriate, as they can generally perform complex tasks to maintain good glycemic control 1.
- However, for those with multiple chronic conditions or high risk of hypoglycemia, a more relaxed target of 7.5-8.0% is often safer, acknowledging the increased risks of tight glycemic control in older adults, particularly the dangers of hypoglycemia 1. The treatment approach should focus on minimizing hypoglycemia risk and avoiding unnecessary complexity in the medication regimen.
- Medications with low hypoglycemia risk, such as metformin, DPP-4 inhibitors, or GLP-1 receptor agonists, are preferred over sulfonylureas or intensive insulin regimens 1. Regular monitoring is essential, with attention to symptoms of low blood sugar and periodic reassessment of the treatment plan as the patient's health status changes, to balance diabetes control with quality of life and safety considerations 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
A1C Target for 70-year-old Patients with Diabetes
The American Diabetes Association recommends different A1C targets for older adults based on their comorbid health status 2. For a 70-year-old patient with diabetes, the following points should be considered:
- A study published in the Journal of Diabetes and its Complications found that A1C levels are not associated with hypoglycemia risk in older adults with type 2 diabetes on insulin therapy 3.
- Another study published in Diabetes Care found that older adults with A1C <7% were not at elevated risk of mortality or hospitalizations, regardless of their health status 2.
- A study published in Diabetes & Metabolism found that an HbA1c level <70mmol/mol (<8.6%) was associated with lower mortality in elderly French type 2 diabetic patients 4.
- A retrospective cohort study published in The Lancet Diabetes & Endocrinology found that both low and high levels of glycemic control were associated with an increased mortality risk, and that a stable glycemic level in the middle range was associated with lower risk 5.
- A study published in Diabetes Care found that increasing Hemoglobin A1c time in range (A1C TIR) reduces adverse health outcomes in older adults with diabetes 6.
Key Findings
- A1C targets should be individualized based on the patient's health status and comorbidities.
- An A1C level <7% may be a reasonable target for some older adults with diabetes, but this should be determined on a case-by-case basis.
- Glycemic variability and stability are important factors in determining mortality risk in older adults with diabetes.
- Maintaining A1C levels within individualized target ranges is associated with lower risk of mortality and cardiovascular disease.
Considerations for A1C Targets
- The patient's overall health status and comorbidities should be taken into account when determining an A1C target.
- The risk of hypoglycemia and other adverse outcomes should be considered when setting an A1C target.
- Glycemic variability and stability should be monitored and taken into account when adjusting treatment plans.
- Individualized A1C targets and treatment plans may be necessary to optimize outcomes for older adults with diabetes.