A1C Monitoring Recommendations for Adults Over 70 Years Old

Target A1C Goals for Older Adults

The American Geriatrics Society recommends A1C targets of 7.5% to 8% for older adults (>70 years) with diabetes, which is less stringent than the 7% target for younger adults 1, 3
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, 2
There is potential harm in lowering A1C to less than 6.5% in older adults with type 2 diabetes mellitus 1

Older adults with diabetes whose individual targets are not being met should have A1C levels measured at least every 6 months 4, 1
For older adults with stable A1C over several years, measurement every 12 months may be appropriate 4, 1
More frequent monitoring (quarterly) is appropriate when therapy has changed or for individuals not meeting glycemic goals 5

The risk-benefit equation changes significantly in older adults due to increased risk of hypoglycemia with age 6
Polypharmacy concerns and drug-drug interactions are also a consideration in older adults 6, 4
Limited life expectancy reduces the benefit from tight control 1, 2

Self-monitoring of blood glucose should be tailored based on functional and cognitive abilities 1, 3
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 2
The American College of Physicians suggests that physician performance measures should not have any A1C targets for adults aged ≥80 years 2

Continue monitoring A1C but adjust targets based on overall health status and comorbidities 1, 2
Functional status and cognitive abilities should also be considered when adjusting A1C targets 1
Life expectancy is another factor to consider when determining A1C targets 1, 2
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 2