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Abstract
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.Kirkman et al. (2012), global Guidelines for Managing Older People with Type 2 Diabetes. In. Brussels and Belgium: International Diabetes Federation (2014), Sinclair AJ, Paolisso G, Castro M, Bourdel-Marchasson I, Gadsby R, Rodriguez Manas L. European Diabetes Working Party for Older People (2011), Munshi et al. (2016) 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, and again after de-intensification to once-a-day basal insulin with non-insulin agents.
Results
We assessed 65 patients; mean age76 ± 6 years on average 3·7 ± 1·3 insulin injections/day. At baseline, 26% of the patients had A1C < 7% (53 mmol/mol), 42% between 7·1–8% (54–64 mmol/mol), 21% between 8·1–9% (65–75 mmol/mol), and 11% >9% (76 mmol/mol). The duration of hypoglycemia (<70 mg/dl, <60 mg/dl, <50 mg/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.
http://www.jdcjournal.com/article/S1056-8727(16)31030-3/fulltext
