From the Guidelines
For a 91-year-old patient with Type 2 Diabetes Mellitus, target blood sugar levels should generally be less stringent than for younger adults, with fasting blood glucose goals of 100-200 mg/dL (5.6-11.1 mmol/L) and HbA1c targets of 7.5-8.5%. This more relaxed approach is appropriate due to the increased risk of hypoglycemia in elderly patients, which can lead to falls, cognitive impairment, and cardiovascular events 1. The patient's functional status, cognitive abilities, and presence of other medical conditions should be considered when setting these targets.
Key Considerations
- Treatment should focus on avoiding hypoglycemia and hyperglycemia symptoms rather than achieving tight control.
- Medication choices should favor those with lower hypoglycemia risk, such as metformin (if kidney function allows), DPP-4 inhibitors, or GLP-1 receptor agonists, while using insulin or sulfonylureas with caution 1.
- Regular blood glucose monitoring is important, especially if the patient is on insulin or sulfonylureas, with attention to signs of low blood sugar like confusion, dizziness, or weakness.
- The overall goal is to maintain quality of life while preventing diabetes complications and avoiding treatment-related adverse events.
Evidence-Based Recommendations
- The American College of Physicians recommends HbA1c targets of 7% to 8% for most patients with type 2 diabetes, but suggests that less stringent targets (such as 8% to 9%) may be appropriate for patients with limited life expectancy, significant comorbid conditions, or a history of severe hypoglycemia 1.
- The American Diabetes Association recommends individualizing glycemic targets based on patient characteristics, such as disease duration, life expectancy, and presence of microvascular or macrovascular complications 1.
- A study published in 2019 suggests that relaxing A1C targets to 8% or 8.5% may be appropriate for older adults with shortened life expectancies and significant comorbidities 1.
From the Research
Target Blood Sugar Levels for a 91-year-old Patient with Diabetes Mellitus Type 2
- The target blood sugar levels for a 91-year-old patient with Diabetes Mellitus (DM) type 2 are not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, according to the study 3, normal people have fasting sugar levels that generally run between 70-110 mg/dl.
- For patients with diabetes, the study 4 mentions that the mean SMBG decreased significantly to 122.6 +/- 21.9 mg/dl in one group and 151.6 +/- 37.7 mg/dl in another group, indicating that the target blood sugar levels may vary depending on the treatment and management program.
- The American Diabetes Association recommends the following blood glucose targets for people with diabetes:
- It is essential to note that the management of diabetes in older adults should be individualized, taking into account their overall health, functional status, and quality of life 2, 5, 6.