title: What is the proper use of hemoglobin A1c monitoring in the elderly?
abstract: Diabetes mellitus (DM) is a major health problem for the aging population. Glycemic control is fundamental to the management of diabetes, as glycemic levels are closely linked to development of diabetes-related complications. Measurement of the hemoglobin A1c (A1c) to assess chronic glycemic control is an integral component of diabetes care. Currently, there is no clear evidence that age alters the relationship between A1c and average blood glucose. The Diabetes Control and Complications trial and the United Kingdom Prospective Diabetes Study are the 2 main studies that have provided evidence leading to the widespread recommendation of A1c monitoring. The American Diabetes Association recommends achieving an A1c level of 7% or lower. However, older diabetics represent a heterogeneous population ranging from frail nursing home residents to active community-dwelling elderly with variable life expectancies. One needs to look at the individual in order to best balance risk versus benefit associated with tight glycemic control. Benefits of intensive therapy in an effort to lower A1c must always be weighed against the greater risk of disabling and unpredictable hypoglycemia, as the geriatric population is less likely to benefit from reducing the risk of microvascular complications and more likely to suffer serious adverse effects from hypoglycemia.
authors.affiliation: UCLA Multicampus Program in Geriatrics and Gerontology, Los Angeles, CA 90073, USA.
authors.forename: Tarannum
authors.initials: T
authors.lastname: Alam
authors.forename: Nancy
authors.initials: N
authors.lastname: Weintraub
authors.forename: Jane
authors.initials: J
authors.lastname: Weinreb
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000517:prevention & control*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods; D009735:Nursing Homes; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin