Is checking Hemoglobin A1c (HbA1c) levels after age 70 not recommended?

A1C Monitoring Recommendations for Adults Over 70 Years Old

A1C monitoring remains recommended for adults over 70 years old with diabetes, but with less stringent targets (7.5-8%) and potentially reduced frequency (annually) for those with stable glycemic control. 1

Target A1C Goals for Older Adults

• For older adults (>70 years), A1C targets should generally be 7.5% to 8%, which is less stringent than the 7% target for younger adults 1
• For healthy older adults with few comorbidities and good functional status, A1C between 7% and 7.5% may be appropriate if achievable without significant risk of hypoglycemia 1
• Higher A1C targets (8-9%) are appropriate for older adults with multiple comorbidities, poor health, and limited life expectancy 1
• There is potential harm in lowering A1C to less than 6.5% in older adults with type 2 diabetes mellitus 1, 2

Monitoring Frequency Recommendations

• Older adults with diabetes whose individual targets are not being met should have A1C levels measured at least every 6 months 1
• For older adults with stable A1C over several years, measurement every 12 months may be appropriate 1
• More frequent monitoring (quarterly) is appropriate when therapy has changed or for individuals not meeting glycemic goals 1, 3

Rationale for Modified Targets and Monitoring in Older Adults

• The risk-benefit equation changes significantly in older adults due to:

  • Increased risk of hypoglycemia with age 1, 2
  • Polypharmacy concerns and drug-drug interactions 1
  • Limited life expectancy reducing benefit from tight control 1
  • Reduced likelihood of developing long-term microvascular complications 4

• A recent study showed that higher A1C goals do not necessarily protect against hypoglycemia in older adults on insulin therapy, suggesting that monitoring remains important regardless of target 2

Special Considerations for Monitoring in Older Adults

• Self-monitoring of blood glucose should be tailored based on functional and cognitive abilities 1
• For frail older adults or those with cognitive impairment, the focus should be on avoiding symptomatic hyperglycemia and preventing hypoglycemia rather than achieving specific A1C targets 1
• The American College of Physicians suggests that physician performance measures should not have any A1C targets for adults aged ≥80 years 1

Clinical Approach to A1C Monitoring After Age 70

• Continue monitoring A1C but adjust targets based on:

  • Overall health status and comorbidities 1
  • Functional status and cognitive abilities 1
  • Risk of hypoglycemia with current therapy 1, 2
  • Life expectancy 1

• For older adults with severe or frequent hypoglycemia, evaluate the management plan and consider referral to diabetes specialists 1

• When A1C levels fall below 6.5% in older adults on medication, consider de-escalation of therapy to reduce hypoglycemia risk 1