From the Guidelines
For a 70-year-old man with an A1c of 6.3%, the management should focus on minimizing symptoms related to hyperglycemia rather than targeting a specific HbA1c level, as the harms of intensive glycemic control may outweigh the benefits in this age group. According to the American College of Physicians guidance statement 1, clinicians should personalize goals for glycemic control based on a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care. Given the patient's age, an HbA1c level of 6.3% is already relatively well-controlled, and the focus should be on maintaining this level without causing undue harm or burden.
- The patient should be encouraged to maintain a healthy lifestyle, including a balanced diet and regular physical activity, to help manage blood glucose levels.
- Regular monitoring with A1c testing every 6-12 months is recommended to assess the effectiveness of the management plan and make adjustments as needed.
- Medication is not necessarily indicated at this A1c level in an older adult unless other risk factors or complications are present, as the risks of hypoglycemia and other adverse effects may outweigh the benefits of tighter glycemic control.
- If treatment becomes necessary, metformin would typically be the first-line medication, but the decision to initiate therapy should be made on a case-by-case basis, taking into account the patient's individual characteristics, preferences, and health status.
- Comprehensive care should also include management of other cardiovascular risk factors like hypertension and dyslipidemia, along with appropriate cancer and vision screenings, as recommended by the American College of Physicians guidance statement 1.
From the Research
Management of A1c 6.3 in a 70-year-old Man
- The American Diabetes Association recommends different A1C targets in older adults based on comorbid health status 2.
- For a 70-year-old man with an A1c of 6.3, the management approach would depend on his overall health status and the presence of any comorbidities.
- A study published in 2021 found that older adults with diabetes who achieved an A1C level <7% had lower mortality and hospitalization rates compared to those with A1C levels ≥8% 2.
- Another study published in 2021 found that increasing hemoglobin A1c time in range (A1C TIR) was associated with reduced adverse health outcomes in older adults with diabetes 3.
- In terms of treatment, metformin is often the first-line medication for type 2 diabetes, and adding a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a sulfonylurea may be considered for patients who require additional glucose-lowering therapy 4, 5.
- A meta-analysis published in 2018 found that SGLT2 inhibitors as add-on to metformin and sulfonylurea treatment were effective in reducing HbA1c, fasting plasma glucose, and body weight, with a significant reduction in blood pressure and triglycerides 5.
- However, the choice of treatment should be individualized based on the patient's specific needs and health status, and regular monitoring of A1C levels and other health outcomes is necessary to adjust the treatment plan as needed 6.