Liberating A1C goals in older adults may not protect against the risk of hypoglycemia
Medha N Munshi1, Christine Slyne2, Alissa R Segal3
1Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215; Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115.
Insights
In older adults with diabetes on insulin, Hemoglobin A1C levels did not correlate with hypoglycemia risk. Adjusting A1C goals does not appear to prevent hypoglycemia in this population.
Area of Science:
- Gerontology
- Endocrinology
- Diabetes Management
Background:
- Hemoglobin A1C (HbA1c) is a key metric for diabetes glycemic control.
- Current guidelines suggest more lenient HbA1c targets for older adults to mitigate hypoglycemia risk.
- Optimal HbA1c levels for this demographic remain undefined.
Purpose of the Study:
- To investigate the association between HbA1c levels and the incidence of hypoglycemia in elderly patients with diabetes on insulin therapy.
- To determine if higher HbA1c targets offer protection against hypoglycemic events in older adults.
Main Methods:
- A prospective study involving continuous glucose monitoring (CGM) in older adults using insulin.
- Measurements of hypoglycemia duration and HbA1c were taken at baseline (multiple daily insulin injections) and after treatment de-intensification (once-daily basal insulin with non-insulin agents).
Main Results:
- Sixty-five patients (mean age 76±6 years) were analyzed.
- Hypoglycemia duration (at <70 mg/dL, <60 mg/dL, <50 mg/dL) showed no significant difference across various HbA1c groups (<7%, 7.1-8%, 8.1-9%, >9%).
- This lack of association persisted irrespective of insulin regimen intensity.
Conclusions:
- HbA1c levels are not demonstrably linked to hypoglycemia risk in older individuals with type 2 diabetes on insulin.
- Elevating HbA1c targets does not appear to confer protection against hypoglycemia in this patient group.
Aims:
Hemoglobin A1C is universally used as a marker for glycemic control and to establish glycemic goals in patients with diabetes. In the older population, experts recommend liberating A1C goals to decrease the risk of hypoglycemia. However, it's not clear which A1C level is optimal for this purpose. This study's aim was to understand the relationship between A1C levels and risk of hypoglycemia.
Methods:
In a prospective study, we performed continuous glucose monitoring (CGM) on older adults on insulin. Hypoglycemia duration and A1C were measured at baseline while patients were on multiple insulin injections, and again after de-intensification to once-a-day basal insulin with non-insulin agents.
Results:
We assessed 65 patients; mean age76±6years with on average 3.7±1.3 insulin injections/day. At baseline, 26% of the patients had A1C<7% (53mmol/mol), 42% between 7.1% and 8% (54-64mmol/mol), 21% between 8.1% and 9% (65-75mmol/mol), and 11% >9% (76mmol/mol). The duration of hypoglycemia (<70mg/dl, <60mg/dl, <50mg/dl) was not different between the A1c groups, regardless of treatment intensity (multiple insulin injections or once-a-day-basal insulin with non-insulin agents).
Conclusions:
A1C levels are not associated with hypoglycemia risk in older population with type-2 diabetes on insulin therapy. Higher A1C goals do not protect against hypoglycemia.
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