Goal <7% for most pts. Can use ≥7.5-8% as the A1C goal if pt has h/o severe hypoglycemia or other comorbidities.
“The treatment of diabetes mellitus in frail elderly patients, especially nursing home residents, can be less stringent than with other patients. Sliding-scale insulin and diabetic diets should both be avoided in nursing home residents. Lowering LDL-cholesterol levels and aggressive blood pressure control are not indicated for frail elderly patients. The acceptable levels of hemoglobin A1c can also be liberalized, with levels of 8%–9% being acceptable.” ABFM
ACP 2018 Guidelines
“Guidance Statement 1: Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients’ preferences, patients’ general health and life expectancy, treatment burden, and costs of care.
Guidance Statement 2: Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.
Guidance Statement 3: Clinicians should consider de-intensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%.
Guidance Statement 4: Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe COPD or CHF) because the harms outweigh the benefits in this population.” ACP 2018
Reference
Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians. Ann Intern Med. [Epub ahead of print 6 March 2018] doi: 10.7326/M17-0939
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