Table
1: Consensus framework for considering
treatment goals for glycemia in older adults with diabetes. Adapted with
permission from American Diabetes Association Older Adults. Section 10. In
Standards of Medical Care in Diabetes - 2016. Diabetes Care 2016; 39 (Suppl.
1): S81-S85.
Patient characteristics/health
status |
Rationale |
Reasonable A1C goal |
Fasting or pre-prandial glucose |
Bedtime glucose |
Healthy (few coexisting chronic
illnesses, intact cognitive and functional status) |
Longer remaining life expectancy |
< 7.5% |
90-130 mg/dL |
90-150 mg/dL |
Complex/intermediate (multiple
coexisting chronic illnesses* or 2+ instrumental ADL impairments
or mild-to-moderate cognitive impairment) |
Intermediate remaining life
expectancy, high treatment burden, hypoglycemia vulnerability, fall risk |
< 8.0% |
90-150 mg/dL |
100-180 mg/dL |
Very complex/poor health (LTC or
end-stage chronic illnesses** or moderate-to-severe cognitive
impairment or 2+ ADL dependencies) |
Limited remaining life expectancy
makes benefit uncertain |
< 8.5% |
100-180 mg/dL |
110-200 mg/dL |
*Coexisting chronic illnesses are conditions serious
enough to require medications or lifestyle management and may include
arthritis, cancer, congestive heart failure, depression, emphysema, falls,
hypertension, incontinence, stage 3 or worse chronic kidney disease, myocardial
infarction, and stroke. By “multiple,” the authors mean at least three, but
many patients may have five or more.
**The presence of
a single end-stage chronic illness, such as stage 3-4 congestive heart failure
or oxygen-dependent lung disease, chronic kidney disease requiring dialysis, or
uncontrolled metastatic cancer, may cause significant symptoms or impairment of
functional status and significantly reduce life expectancy. Abbreviations: LTC: Long-term care;
ADL: Activities of Daily Living.