What should be the A1c goal for older adults with diabetes?
● In the absence of any long-term clinical trial data in fit older populations and in those with life expectancy of >10 years, an A1C goal of <7.5 percent (58.5 mmol/mol) should be considered in medication-treated patients.
What is a good hemoglobin A1c for a 65 year old?
The new advice is: Avoid using medications to achieve hemoglobin A1c less than 7.5% in most adults age 65 and older; moderate control is generally better. What is the ‘A1c’? The ‘A1c’ is a protein—the hemoglobin A1c—produced in your blood in response to the level of sugar.
Is lowering your A1c level better for seniors?
You may have read that the lower your A1C level, the better. For best health, people with diabetes should aim for glucose as close to normal as possible. But some new research shows this may not be true for older people. According to these studies, seniors could decide not to shoot for tight control of blood sugar or cholesterol.
What is the normal range for A1C to increase?
Your A1C Result. A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes.
At what A1C should medication be started?
What A1c levels require medication/treatment? There is no specific A1c level that makes it necessary for you to be on medication. While an A1c of 6.5% or higher is indicative of diabetes, some people may need to start taking medication for an A1c under 6.5%.
What is an acceptable A1C in elderly?
The American Geriatrics Society recommends a goal a1c of 7.5-8% in older patients with moderate comorbidities and life expectancy less than 10 years;7 the American Diabetes Association recommends a more relaxed goal of 8-8.5% for older patients with complex medical issues. 1.
What is the normal fasting blood sugar level for a 70 year old?
A normal fasting blood glucose level is between 70 and 100 mg/dl (milligrams per deciliter of blood).
What are the new guidelines for A1C 2021?
ADA now recommends A1C below 7% or TIR above 70%, and time below range lower than 4% for most adults. In previous years, the Standards of Care included an “A1C Testing” subsection that recommended people with diabetes test their A1C two to four times a year with an A1C target below 7%.
Does HbA1c increase with age?
Aging is associated with increased HbA1c levels, independently of glucose levels and insulin resistance, and also with decreased HbA1c diagnostic specificity. Diabet Med.
How do you manage diabetes in old age?
9 Ways Older People Can Manage Their Diabetes to Stay HealthierEat Healthy. ... Stay Active. ... Check Glucose Levels Regularly. ... Never Miss a Dose of Medication. ... Get Blood Pressure and Cholesterol Levels Checked Regularly. ... Examine Your Feet Every Day. ... Get Vaccinated. ... Hearing Tests.More items...•
What is normal blood sugar by age?
Target blood sugar levels for children and adolescents with diabetesTarget blood sugar levels for children and adolescents with diabetesAge 6-12Blood sugar in mg/dLFasting80-180Before meal90-1801-2 hours after eatingUp to 1401 more row
What is the A1C target for diabetics?
In these official guidelines, they recommend an A1C target of 7.5% for healthy people over 65, as compared to 7.0% for younger people.
What is the best BMI for a 65 year old?
For people over 65, though, the optimum BMI is about 27.5. BMI is a measure that compares your weight with your height. If you know those numbers, you can calculate your own BMI here. An older 5’8″ person with a BMI of around 27.5 would weigh 180 pounds and would be classed as overweight, but he would have the longest life expectancy.
Can you live your life with an A1C of 6?
Of course, everyone is different. If you want an A1C of 6 or less, and can work for that without dangerous side effects, and feel good doing it, go for it. But the point is not to live your life to reach a particular number on a lab test.
Can seniors control blood sugar?
According to these studies, seniors could decide not to shoot for tight control of blood sugar or cholesterol. One study from Japan showed that lower HbA1c levels (a measure of average glucose control over the previous 2–3 months) were actually linked with an increased the risk of frailty in older adults.
Is A1C level lower for seniors?
Elderly A1C Targets. You may have read that the lower your A1C level, the better. For best health, people with diabetes should aim for glucose as close to normal as possible. But some new research shows this may not be true for older people. According to these studies, seniors could decide not to shoot for tight control ...
When was A1C recommended?
The A1C become more widespread since an international committee of experts recommended it in 2009 as a way to help diagnose both type 2 diabetes and a condition known as pre-diabetes. (In 2010, the American Diabetes Association included the A1C in its clinical practice recommendations, too.)
Why should the A1C be changed?
Here is why and what some doctors think should change. Because the A1C is so new, doctors are still learning what number is the best goal for diabetes control. In 1986 the testing program was given to doctors to provide a clearer picture of blood sugar control in diabetics. They hoped to find that a lower number on the A1C improved diabetic ...
What is the A1C goal for diabetes?
Reviewed by Clifton Jackness, MD, Attending Physician in Endocrinology, Lenox Hill Hospital and the Mount Sinai Medical Center, New York, NY Assessment of glycemic control in patients with type 2 diabetes can be achieved through patient self-monitoring of blood glucose (SMBG) and A1C determinations.1,2 The American Diabetes Association (ADA) recommends regular A1C testing to evaluate the effectiveness of current management strategies, but the target A1C goal can vary depending on the individual patient profile as well as the set of professional consensus recommendations—and associated management philosophy—to which the treating clinician adheres. According to the ADA, the generally accepted standard A1C goal for adult patients with type 2 diabetes is 7.0%.1,2 Driving A1C below this level has been shown to reduce microvascular complications. In addition, if achieved quickly after a diabetes diagnosis, this A1C goal has been associated with a long-term reduction in macrovascular disease as well.1,2 The ADA suggests that physicians may lower the A1C target to 6.5% for some individuals with short duration of diabetes, a long life expectancy, and no significant cardiovascular disease if the target can be achieved without significant adverse effects of therapy, most notably hypoglycemia.2 Conversely, the ADA suggests a target A1C of closer to 8.0% for individuals with any of the following: history of severe hypoglycemia limited life expectancy advanced microvascular or macrovascular complications multiple comorbidities The higher target A1C is also recommended for patients for whom long-term management of diabetes with behavior modification, SMBG, and glucose-lowering therapy has not helped attain a lower target goal.1,2 These ADA recommendations are partly based on studi Continue reading >>
What does 7.5% A1C mean?
An A1c of 7% indicates an average blood sugar of 154; 7.5% means it’s been 168; 8.0%, it’s 182; for 9.0%, it’s 211. The AGS found no evidence that tight control in older adults with type 2 diabetes is beneficial.
What is the target glycated hemoglobin level for T2DM?
Objective New guidelines recommend a target glycated hemoglobin (HbA1c) of 7.5% to 8.0% in elderly persons with type 2 diabetes mellitus (T2DM), but real-world data regarding outcomes associated with different HbA1c levels in the elderly are limited. This study assessed outcomes and their association with defined HbA1c thresholds and age ranges in insulin-treated, elderly, patients with T2DM in long-term care (LTC). Design Retrospective analysis of medical charts and the Minimum Data Set (MDS) for the period September 2010 through September 2011. Setting A total of 117 nursing homes in the United States. Participants Eligible patients had resided in LTC for 3 months or more, had at least 1 full MDS assessment, 2 or more records of insulin dispensing with no pump use, and 1 or more HbA1c measurements. Measurements Outcomes that were measured included hypoglycemia, ketoacidosis, infections, falls, hospitalization, and emergency room (ER) visits. Results A total of 583 patients were included (mean age 78.9 years, mean chart observation length 55 days). In all groups, hypoglycemia was lowest in patients with an HbA1c level higher than 9.0%. In patients 75 years or older, infection rates were highest when HbA1c levels were higher than 9.0%. Falls increased by HbA1c level in patients aged 65 to 74 years, but decreased by HbA1c levels in patients 85 years or older. Ketoacidosis, hospitalization, and ER visits were low in all groups. Conclusion These data suggest that better glycemic levels may not necessarily be associated with better clinical outcomes, and different age groups may exhibit different patterns, thereby supporting the call for individualized glycemic control among elderly patients. Continue reading >>
Why is A1C used in labs?
Experts say the switch to more widespread use occurred partly because the labs doing the tests became more standardized, so their results were less likely to vary from lab to lab. The A1C is an easier test, so doctors like to prescribe it in place of the fasting blood glucose or 2-hour oral glucose tolerance tests.
What is the A1C level for type 2 diabetics?
On the diabetic hemoglobin A1C, non-diabetics test in the 4% to 6% range. But a type 2 diabetic can test 10% or higher. Studies find that at levels higher than 8%, the complications multiply.
Why is the incidence of diabetes in the elderly higher?
The incidence of diabetes in the elderly (which is almost always type 2 diabetes) is higher for many reasons, but the main culprit seems to be increasing insulin resistance with aging. Half of the elderly population has prediabetes. A study in Diabetes Care in August 2008 suggests that the increased insulin resistance associated with aging is due to exactly the same causes as that found in younger people, namely physical inactivity and obesity. However, as a result of decreasing height with age, the body mass index (BMI) isn’t a good indicator of obesity in the elderly. The waist circumference is better. A BMI of 30 may not indicate the same level of increased risk of a heart attack in an elderly person as it does in a younger person. A BMI of 30–35 is associated with only a slight increase in risk. The pancreas seems to be able to make insulin at the usual rate. The fasting blood glucose actually rises very slowly as you get older. The glucose after meals, however, rises much quicker and leads to the diagnosis. Because the fasting blood glucose is usually normal, the hemoglobin A1c is used to make the diagnosis in the elderly population. A hemoglobin A1c that is above 6.5 percent is considered diagnostic of diabetes. Results that fall between normal and that value are in a gray zone that probably indicates prediabetes. The Diabetes and Aging Study (Diabetes Care, June 2011) showed that a hemoglobin A1c of 8 percent was associated with the lowest rates of complications and death in older diabetic patients while a level of less than 6 percent was associated with higher death rates. Elderly people with diabetes often don’t complain of any symptoms. When they do, the symptoms may not be the ones usually associated with type 2 diabetes, or they may be confusing. Elder Continue reading >>
What are the ABCs of diabetes?
Optimal management of type 2 diabetes requires treatment of the “ABCs” of diabetes: A1C, blood pressure, and cholesterol (ie, dyslipidemia ). This web page provides the rationale and targets for glucose management; AACE guidelines for blood pressure and lipid control are summarized in Management of Common Comorbidities of Diabetes. Glucose Targets Glucose goals should be established on an individual basis for each patient, based on consideration of both clinical characteristics and the patient's psycho-socioeconomic circumstances.1-3 Accordingly, AACE recommends individualized glucose targets (Table 1) that take into account the following factors1,2: Life expectancy Duration of diabetes Presence or absence of microvascular and macrovascular complications Comorbid conditions including CVD risk factors Risk for development of or consequences from severe hypoglycemia Patient's social, psychological, and economic status Table 1. AACE-Recommended Glycemic Targets for Nonpregnant Adults1,2 Parameter Treatment Goal Hemoglobin A1C Individualize on the basis of age, comorbidities, and duration of disease ≤6.5 for most Closer to normal for healthy Less stringent for “less healthy” Fasting plasma glucose (FPG) <110 mg/dL 2-hour postprandial glucose (PPG) <140 mg/dL The American Diabetes Association (ADA) also recommends individualizing glycemic targets (Table 2) based on patient-specific characteristics3: Patient attitude and expected treatment efforts Risks potentially associated with hypoglycemia as well as other adverse events Disease duration Life expectancy Important comorbidities Established vascular complications Resources and support system Table 2. ADA-Recommended Glycemic Targets for Nonpregnant Adults3 Parameter Treatment Goal Hemoglobin A1C <6.5% for patients Continue reading >>
How often should I get my A1C?
If you have diabetes, get an A1C test at least twice a year, more often if your medicine changes or if you have other health conditions. Talk to your doctor about how often is right for you.
What is the normal A1C level?
A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes. Managing Diabetes.
Why is A1C important?
It’s one of the commonly used tests to diagnose prediabetes and diabetes, and is also the main test to help you and your health care team manage your diabetes. Higher A1C levels are linked to diabetes complications, so reaching and maintaining your individual A1C goal is really important if you have diabetes.
How often should I repeat my A1C test?
Repeat the A1C test as often as your doctor recommends, usually every 1 to 2 years. If you don’t have symptoms but your result shows you have prediabetes or diabetes, get a second test on a different day to confirm the result. If your test shows you have diabetes, ask your doctor to refer you to diabetes self-management education ...
What does A1C mean?
The A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin.
What is the goal for diabetes?
The goal for most people with diabetes is 7% or less. However, your personal goal will depend on many things such as your age and any other medical conditions. Work with your doctor to set your own individual A1C goal.
Where to get A1C blood test?
The test is done in a doctor’s office or a lab using a sample of blood from a finger stick or from your arm. You don’t need to do anything special to prepare for your A1C test. However, ask your doctor if other tests will be done at the same time and if you need to prepare for them.
What is the A1C target?
Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus : A guidance statement update from the American College of Physicians. Annals of Internal Medicine, March 2018.
What should be the cornerstone of treatment for type 2 diabetes?
Lifestyle change should be the cornerstone of treatment for type 2 diabetes. The recommendations go on to say that for patients who achieve an A1c below 6.5% with medications, we should decrease or even discontinue those drugs.
Do you have to follow A1C?
We don’t even need to follow the A1c for some patients. Elderly patients, and those with serious medical conditions, will benefit from simply controlling the symptoms they have from high blood sugars, like frequent urination and incontinence, rather than aiming for any particular A1c level.
Does lifestyle change help with diabetes?
Lifestyle change also can help achieve healthy blood pressure and cholesterol levels, which in turn reduce the risk for heart disease. And heart disease is a serious and common complication of diabetes. Lifestyle change should be the cornerstone of treatment for type 2 diabetes.
Is there any evidence that diabetes medication can cause low blood sugar?
There is little to no evidence for any meaningful benefit of intervening to achieve a target A1c in these populations; there is plenty of evidence for harm. In particular, diabetes medications can cause low blood sugars, leading to weakness, dizziness, and falls.
What is the treatment for type 2 diabetes in older patients?
The initial treatment of type 2 diabetes in older patients is similar to that in younger patients and includes counseling on nutrition, physical activity, optimizing metabolic control, and preventing complications.
What age group is at risk for microvascular complications?
Older adults (>65 years) with diabetes are at risk of developing a similar spectrum of microvascular complications as their younger counterparts, albeit probably at lower absolute risk if they develop diabetes later in life, which will limit duration.
What are the complications of diabetes mellitus in older adults?
Older adults with diabetes are at risk of developing a similar spectrum of microvascular complications as their younger counterparts with diabetes. Retinopathy, nephropathy, and foot problems are all important complications of diabetes mellitus in older patients.
How often should you monitor creatinine levels?
In addition, kidney function (measurement of serum creatinine and eGFR) should be monitored every three to six months, rather than annually. (See "Metformin in the treatment of adults with type 2 diabetes mellitus", section on 'Contraindications' .)
How to improve glycemic control?
Weight reduction (if needed) through diet, exercise, and behavioral modification can be used to improve glycemic control, although the majority of older patients with type 2 diabetes will require medication over the course of their diabetes.
Is metformin safe for older adults?
Metformin is an attractive agent to use in older adults due to a low risk of hypoglycemia. Healthy older adults may be treated similarly as younger adults with initiation of metformin at the time of diabetes diagnosis, even if the presenting A1C is below the individualized medication-treated target.
Is aspirin safe for diabetes?
A meta-analysis of a large number of secondary prevention trials found that the absolute benefit of aspirin was greatest in those over age 65 years with diabetes or diastolic hypertension [ 30 ]. The role of aspirin for the primary prevention of cardiovascular events in patients with diabetes is less certain.
