Liberating A1C goals in older adults may not protect against the risk of hypoglycemia.
OBJECTIVE
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. 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 again after de-intensification to once-a-day basal insulin with non-insulin agents.


RESULTS
We assessed 65 patients; mean age76±6years with on average 3.7±1.3 insulin injections/day. At baseline, 26% of the patients had A1C<7% (53mmol/mol), 42% between 7.1% and 8% (54-64mmol/mol), 21% between 8.1% and 9% (65-75mmol/mol), and 11% >9% (76mmol/mol). The duration of hypoglycemia (<70mg/dl, <60mg/dl, <50mg/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.
Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215; Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115. Electronic address: medha.munshi@joslin.harvard.edu.
Medha N
MN
Munshi
Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215.
Christine
C
Slyne
Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215; Massachusetts College of Pharmacy and Health Sciences University, 179 Longwood Ave, Boston, MA, 02115.
Alissa R
AR
Segal
Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215.
Nora
N
Saul
Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215.
Courtney
C
Lyons
Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115.
Katie
K
Weinger
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D001900:Boston / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018670:Monitoring, Ambulatory; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012306:Risk; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D013453:Sulfonylurea Compounds; C517652:hemoglobin A1c protein, human
Geriatrics; Hemoglobin A1c; Hypoglycemia; Insulin; Older adults