It may be better for older people with type 2 diabetes to have less stringent A1C goals than younger type 2s, according to new guidelines from the American Diabetes Association and the European Association for the Study of Diabetes.
The recommendations, published on April 19, mark a change from previously accepted thought that everyone with type 2 diabetes should pursue an A1C below 7%. (The ADA is now recommending an even lower A1C than before: 6% to 6.5%. An A1C below 5.6% is generally accepted as indicating a diabetes-free state.)
The new thinking is that an A1C of below 7% is a suitable goal for young, healthy, motivated people who have the energy to make the effort to attain it. The new recommendations call for type 2s aged 65 years and older to focus on achieving less stringent A1C targets, ranging from 7.5% to 8%. The reasoning behind the change is concern about older people’s greater vulnerability to hypoglycemia, as well the effect that the numerous drugs they may be taking could have on their effort to achieve a low A1C.
The ADA and EASD guidelines also call for metformin as the first-line treatment for newly diagnosed cases of type 2. The only exception is people whose A1C after diagnosis is close enough to normal to try lifestyle changes alone to manage the disease. The guidelines call for the addition of a second drug if three months of metformin alone does not bring down their A1C sufficiently.
According to both associations, the new guidelines take a more patient-centered approach, matching blood sugar goals to the patient in terms of age and medical history, rather than demanding a one-size-fits-all percentage.