Glycemic targets for older adults with type 2 diabetes
Clinicians have not adapted to looser glycosylated haemoglobin targets. Older people are more prone to antidiabetes drug side effects and have less time to benefit from glycemic management. American Diabetes Association (ADA) lowered glycemic targets for older patients. Glycosylated haemoglobin (HbA1c) Hbc goals include 7.5% for generally healthy older people, 8 % for those with multiple chronic conditions, and symptomatic hyperglycemia (but no precise target) for those in poor health.
To determine whether clinical practice fit with developing guidelines between 2001 and 2018, researchers analysed diabetes management in 3500 older U.S. individuals (age 65). Each HbA1c measurement was compared to the ADA's glycemic objectives in that year, based on the patient's health state. From 2001 to 2018, the percentage of patients with HbA1c ≥1% below goal climbed from 16% to 43%. Half of the hypoglycemic patients took hypoglycemic medicines. More than half of poor-health diabetics with HbA1c ≥1% below aim.
Poor health patients were most likely to have HbA1c considerably below goal and use hypoglycemic medications, indicating a gap between guidelines and clinical practice.