A1C Monitoring in Comfort Care Patients

Rationale for Discontinuing A1C Testing

• The American Diabetes Association recommends A1C testing at least twice yearly for patients pursuing disease-modifying care, with the goal of guiding treatment adjustments to prevent long-term complications, but this is not applicable to comfort care patients 1, 2.
• A1C testing is designed to prevent microvascular and macrovascular complications that develop over years, making it not relevant for comfort care patients with limited life expectancy 1, 2.

Alternative Approach to Glycemic Management in Comfort Care

• The American Diabetes Association suggests focusing on symptom-based management rather than laboratory-driven targets, monitoring for symptomatic hyperglycemia and hypoglycemia through clinical assessment rather than routine laboratory testing 1.
• Point-of-care glucose monitoring should only be used when symptoms suggest problematic glycemic excursions that are affecting quality of life, as recommended by the American Diabetes Association 1, 4.
• Simplifying diabetes regimens to minimize hypoglycemia risk and treatment burden is recommended, which may include discontinuing medications with high hypoglycemia risk or those requiring frequent monitoring, according to the American Diabetes Association 1.

Common Pitfalls to Avoid

• Continuing routine A1C testing simply because "it's always been done" represents low-value care that does not serve the patient's comfort-focused goals, as stated by the American Diabetes Association 1, 2.
• Avoiding tight glycemic control targets (A1C <7%) in comfort care patients is recommended, as these increase hypoglycemia risk and treatment burden without providing meaningful benefit given limited life expectancy, according to the American Diabetes Association 1, 4.
• Not using A1C results to intensify therapy in comfort care patients is recommended, as this contradicts the fundamental principle of minimizing treatment burden, as stated by the American Diabetes Association 2, 3.