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Whittington Health NHSUCL

Blood glucose control in older adults

Blood glucose (blood sugar) control has been at the heart of diabetes care for decades. A well-controlled blood glucose level can improve symptoms and reduce the risk of complications. But what blood glucose level should you aim for? Are targets different for older adults?

Decisions about blood glucose control are a balance between the risks and benefits of medication. A ‘one-size-fits-all’ approach doesn’t work and so recent guidelines recommend that blood glucose targets are personalised (2, 3).

Researchers in the US have reviewed clinical studies where intensive diabetes treatments were used (4) but they found that very few people over 80 were included. Complications like heart attack and stroke were not measured, and particular patient groups and medications were not compared in a way that helps us understand how to personalise treatment.

However they were able to use the evidence available to offer the following advice:

  • Older people do not benefit from strict blood glucose control as it doesn’t reduce the risk of heart attack and stroke.
  • Some older people might actually benefit from taking fewer medicines, especially if their HbA1c is below target.
  • Strict blood glucose control increases the risk of low blood glucose (hypoglycaemia) in people who are either: over 80 years of age, on insulin, or who have had diabetes for longer. For people like this, HbA1c targets should be higher rather than lower.

The decision on what blood glucose level to aim for should be made after weighing up the pros and cons of intensive treatment. For older adults a higher HbA1c target between 58 and 75 mmol/mol (7.5-9.0%) will provide benefits and reduce risk.

Younger people or people recently diagnosed will benefit from a lower HbA1c between 48 and 58 mmol/mol (6.5-7.5%) depending on other factors like the number of diabetes medicines prescribed or other medical problems.

REFERENCES

  1. Huang ES LN, Liu JY, John PM, Moffet HH, Karter AJ, . Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study. JAMA Intern Med. 2014;174(2):251-8.
  2. American Diabetes Association. Standards of medical care in diabetes Diabetes Care 2015;38(suppl 1)(S1-S93).
  3. National Institute for Health & Care Excellence. Type 2 diabetes in adults: management. 2015.
  4. Lipska KJ KH, Soones T,  Lee SJ, . Polypharmacy in the Aging Patient: A Review of Glycemic Control in Older Adults With Type 2 Diabetes. JAMA. 2016;315(10)