A1C Guidelines for Patients Over Age 70

Introduction to A1C Targeting

The American Diabetes Association recommends a target A1C of 7.5-8.0% for most patients over 70, with higher targets of 8.0-9.0% for those with multiple comorbidities, functional impairment, or limited life expectancy 1

For healthy older adults with few comorbidities and intact function, the American Diabetes Association recommends a target A1C of <7.0-7.5% 1
For patients with multiple comorbidities or mild-moderate cognitive impairment, the American Diabetes Association recommends a target A1C of <8.0% 1
For patients with advanced disease or moderate-severe cognitive impairment, the American Diabetes Association recommends avoiding reliance on A1C and focusing on avoiding hypoglycemia and symptomatic hyperglycemia 1

The American Geriatrics Society notes that older adults ≥80 years are nearly 5 times more likely to be hospitalized for insulin-related hypoglycemia compared to middle-aged adults 3
A1C <6.5% is associated with increased mortality and should prompt immediate treatment deintensification, according to the Journal of the American Geriatrics Society 4

The American Geriatrics Society recommends measuring A1C every 6 months if targets are not being met, and every 12 months for stable patients meeting individualized targets for several years 4

The American Geriatrics Society recommends metformin as the preferred first-line agent unless contraindicated 4
The American Geriatrics Society advises against using glyburide in older adults due to high hypoglycemia risk 4

For patients with life expectancy <5 years, the American Geriatrics Society recommends focusing on symptom management rather than specific A1C targets 4
For patients in skilled nursing facilities or short-term rehabilitation, the American Diabetes Association recommends avoiding reliance on A1C and using a glucose goal of 100-200 mg/dL 1

Before setting A1C targets, the American Diabetes Association recommends evaluating cognitive function, functional status, comorbidities, life expectancy, geriatric syndromes, and social support 1

The American Geriatrics Society notes that physician performance measures should not have A1C targets below 8% for any population and should have no A1C targets for adults ≥80 years 2