Hemoglobin A1c and Mortality in Older Adults With and Without Diabetes: Results From the National Health and Nutrition Examination Surveys (1988–2011)

CONCLUSIONS An HbA1c >8.0% was associated with increased risk of all-cause and cause-specific mortality in older adults with diabetes. Our results support the idea that better glycemic control is important for reducing mortality; however, in light of the conflicting evidence base, there is also a need for individualized glycemic targets for older adults with diabetes depending on their demographics, duration of diabetes, and existing comorbidities.

Source: Diabetes Care

HgA1C and the Prediction of DM2

RESULTS – During long-term follow-up of children and adolescents who did not initially have diabetes, the incidence rate of subsequent diabetes was fourfold (in boys) as high and more than sevenfold (in girls) as high in those with HbA1c ≥5.7% as in those with HbA1c ≤5.3%—greater rate ratios than experienced by adults in the same HbA1c categories. Analyses of ROCs revealed no significant differences between HbA1c, FPG, and 2hPG in sensitivity and specificity for identifying children and adolescents who later developed diabetes. CONCLUSIONS – HbA1c is a useful predictor of diabetes risk in children and can be used to identify prediabetes in children with other type 2 diabetes risk factors with the same predictive value as FPG and 2hPG.

Source: Diabetes Care

Q&A – A1C Levels

Reprinted from Johns Hopkins Health Alert Email

A reader asks, “I’m 72 and my HbA1c level is usually around 8.0 percent, which my doctor says is fine. Should I be taking medication to get it below 7.0 percent?” Here’s our answer.

Not necessarily. Striving for an HbA1c level below 7.0 percent is the goal for many nonpregnant adults with diabetes. However, less aggressive goals may be appropriate for certain groups of patients, including older adults with multiple comorbidities or decreased functional status, or who are at high risk for hypoglycemia.

It remains unclear the degree to which “tight control” benefits older adults given that earlier studies of intensive glucose control in diabetes excluded elderly patients. Indeed, tight control may cause harm, such as hypoglycemia and potentially higher mortality, as suggested in recent studies of older individuals — for example, in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study.

Current advice. The American Geriatrics Society advises adults over 65 who are healthy to aim for an HbA1c between 7.0 and 7.5 percent. If your life expectancy is less than 10 years and you have other chronic conditions, such as heart or kidney disease, a goal of 7.5 to 8.0 percent might be appropriate.

For those with a shorter life expectancy who are being treated for multiple medical conditions, an HbA1c of 8.0 to 9.0 may be reasonable.

However, otherwise healthy and robust older adults may benefit from glycemic targets similar to those recommended for younger adults (HbA1c less than 7 percent). In general, goals of care should be individualized for each patient.