April 17, 2021

Years ago we were happy with a 7.5 A1c for our patients. Over time we have kept lowering the number to 6.0, but we know that euglycemic patients are usually lower than 5.4, so why stop at 6.0?

Part of the reason is the increased risk of hypoglycemia in patients over 65. This arbitrary age line has caused many practitioners to worry about even getting to 6.0. It is important to evaluate your patient’s overall health before you decide the age to back off of therapy. I have a 79 year old cycling friend with type 2 diabetes, who can average 18-20 mph for a couple of hours and gets in about 5000 miles a year. When his doctor told him that he could let his A1c slip up because of his age, he got a new doctor.

Not all of our senior patients with diabetes are in that good of shape, but even for those who are not, there is no reason to give up on lower targets. We have medications now with low or almost nonexistent risk of hypoglycemia, making the management of lower A1c’s easier. This week in our Laterpay feature, our intern, Laura Martínez López, PharmD. Candidate Lake Erie College of Osteopathic Medicine, College of Pharmacy, has a review of the reasons that intensive control can work on most older patients and why keeping the A1c as low as possible makes 100% sense.

 

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We can make a difference!

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Dave Joffe

Editor-in-chief