From the Guidelines
For a 70-year-old white female, the recommended Hemoglobin A1C target range is generally between 7.0% and 8.0%. This recommendation is based on the most recent and highest quality study available, which suggests that a slightly relaxed target is appropriate for older adults due to the increased risk of hypoglycemia and the diminished benefits of intensive glycemic control in those with limited life expectancy 1.
Key Considerations
- Individual factors should be considered when setting goals, including functional status, comorbidities, and hypoglycemia risk.
- For a relatively healthy 70-year-old with few comorbidities and good functional status, a target closer to 7.0% may be appropriate.
- However, for those with multiple comorbidities, cognitive impairment, or limited life expectancy, a target closer to 8.0% would be more suitable to minimize hypoglycemia risk while still providing protection against diabetes complications.
- Regular blood glucose monitoring is important to avoid significant hypoglycemic episodes, which can be particularly dangerous in older adults and may lead to falls, confusion, or cardiovascular events.
Evidence Summary
The American College of Physicians recommends individualized assessment of risk for complications from diabetes, comorbidity, life expectancy, and patient preferences when setting HbA1c targets 1. More recent guidelines suggest that HbA1c targets can be higher in patients with comorbid conditions and limited life expectancy 1. The KDOQI clinical practice guideline for diabetes and CKD also suggests a target HbA1c of 7.0% for patients with diabetes who are at risk of hypoglycemia and have clinically-significant co-morbidities or limited life expectancy 1.
Clinical Implications
The A1C target should be reassessed periodically as health status changes. Pharmaceutical agents should be selected on the basis of efficacy, contraindications, drug interactions, comorbidities, and potential adverse effects, and patients should be engaged with the various treatment options and arrive at a shared treatment plan with their clinician 1.
From the Research
Hemoglobin A1C Range Recommendations
The recommended Hemoglobin A1C range for a 70-year-old white female can be found in the following studies:
- The American Diabetes Association recommends hemoglobin A1C (A1C) goals of < 7% for most non-pregnant adults and < 8% for adult patients with extensive or life-limiting comorbidities 2.
- For older adults, including those over 70, the goal is to balance the risk of hypoglycemia with the benefits of tight glycemic control, and the American Diabetes Association recommends considering individualized targets 3.
- A study published in Diabetes Care found that increasing A1C time in range (A1C TIR) was associated with lower risk of mortality and cardiovascular disease in older adults with diabetes, with individualized target ranges of 6.0-7.0% to 8.0-9.0% 4.
Key Considerations
When determining the recommended Hemoglobin A1C range for a 70-year-old white female, the following factors should be considered:
- The presence of comorbidities and life expectancy 3
- The risk of hypoglycemia and the potential benefits of tight glycemic control 3
- Individualized target ranges based on clinical characteristics and predicted life expectancy 4
Study Findings
The studies found that:
- Hemoglobin A1C testing is an important component of diabetes care, and consistent testing is associated with lower risk of amputation 5
- The American Diabetes Association recommends achieving an A1C level of 7% or lower for most non-pregnant adults 2, 3
- Individualized target ranges and consideration of comorbidities and life expectancy are important for older adults with diabetes 3, 4