New Blood Sugar Guidelines Give Older Type 2s More Latitude

| May 3, 2012

It may be better for older people with type 2 diabetes to have less stringent A1C goals than younger type 2s, according to new guidelines from the American Diabetes Association and the European Association for the Study of Diabetes.

The recommendations, published on April 19, mark a change from previously accepted thought that everyone with type 2 diabetes should pursue an A1C below 7%. (The ADA is now recommending an even lower A1C than before: 6% to 6.5%. An A1C below 5.6% is generally accepted as indicating a diabetes-free state.)

The new thinking is that an A1C of below 7% is a suitable goal for young, healthy, motivated people who have the energy to make the effort to attain it. The new recommendations call for type 2s aged 65 years and older to focus on achieving less stringent A1C targets, ranging from 7.5% to 8%. The reasoning behind the change is concern about older people's greater vulnerability to hypoglycemia, as well the effect that the numerous drugs they may be taking could have on their effort to achieve a low A1C.

The ADA and EASD guidelines also call for metformin as the first-line treatment for newly diagnosed cases of type 2. The only exception is people whose A1C after diagnosis is close enough to normal to try lifestyle changes alone to manage the disease. The guidelines call for the addition of a second drug if three months of metformin alone does not bring down their A1C sufficiently.   

According to both associations, the new guidelines take a more patient-centered approach, matching blood sugar goals to the patient in terms of age and medical history, rather than demanding a one-size-fits-all percentage.

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Categories: A1C, A1C Levels, A1c Test, Blood Glucose Levels, Blood Sugar, Diabetes, Diabetes, Hypoglycemia, Metformin, Monitoring, Type 2 Issues


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Comments

Posted by Anonymous on 3 May 2012

The term "lifestyle changes" sounds pretty meaningless to me.

The ADA and EASD need to work on a simpler, more direct message: If you have diabetes, dramatically reduce your consumption of foods with starches (bread, pasta, potatoes, rice, etc.) and added sugar. These kinds of carbs are toxic to a diabetic. I think the same advice applies to a pre-diabetic also.

In addition, diabetics should be encouraged to test how their bodies react to carbs by taking BG readings one hour after eating a variety of foods.

Posted by chanson3633 on 8 May 2012

This is sort of creepy. It seems like they are saying, "if you are young and energetic, take your treatment seriously; if not take it easy." There is good scientific evidence that A1c of over 7% is associated with diabetes complications. Why would you advise the patient not to try to lessen the risk of complications? If hypoglycemia is the issue, there are ways to dela with that. But I have a hard time believing that hypoglycemia is a serious risk for people who have A1c's over 6.5%

Posted by kilty on 8 May 2012

This is just another attempt by the government to remove our access to successful medical care. If you stop proper care and meds for those over 65 the government has much to gain.
They will not have to make big pay outs to doctors, hospitals and teams for our care.
They will not have to pay for help in recovering from our problems due to Diabetes.
Just think of how they can balance the budget on the backs of the aging population.
My A1c is 6.1 think I will just continue with my current program and see if I can survive past 78.
Just think how many in the over 65 community have worked all their lives and paid into Medicare and Social Security for the pitiful benefits received;they will be dead and the government will not have to pay a dime. What a way to go!

Posted by Anonymous on 9 May 2012

I am in complete agreement with chanson3633. I am 70 and have had type 2 for 10 years. My levels are now creeping up but my doctor says that she will not change treatment until my hba1c is over 7.8% due to my age. What different does age make, the risk of complications is the same regardless and the consequences just as unpleasant. I am from Australia so cannot comment on the cost issue in the US although it is not an issue here. I will continue to argue with my Doctor on this issue. The risk of HYpo is rubbish. They are obviously not talking about active and able seniors.

Posted by Anonymous on 14 May 2012

I am 67 and have been diagnosed with type 2 for 6 years. Managed by losing 50 lbs and increasing my exercise to 30-75 minutes daily while limiting carbs to 175. After 1 1/2 years, added metformin to control BG; another year later went on long and short acting insulins in addition. A1Cs have gone from 6.1 to current 7.6, with hypoglycemic incidents of 47 or 54, sometimes in the middle of the night. On vacation at luxury resort, BG spikes three times what it is at home (and I brought my own food with me!)...I can't watch a movie or the news without a significant BG spike. Food is almost the least of the challenges in reducing BG. Anyway, it's interesting that age is somehow correlated with hypoglycemia, I will have to look into that...it is such a scary experience. Nothing about this disease is intuitive or easy!


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