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Q&A: Diabetes Treatment for Older Adults

Should older diabetics aim for the same hemoglobin A1C level as younger people?

Doctors often fail to cut back on medications even when treatment goals are surpassed.

Two studies published online in JAMA Internal Medicine (10/2015), suggest there is still confusion when it comes to treating the older population for diabetes, with doctors often not cutting back on medications even when treatment goals are surpassed. The first study included more than 211,000 diabetics age 70 and older. The data showed that medications were decreased in just 27 percent of participants with potentially dangerous low blood sugar levels (less than 6 percent as measured by the A1C test, which provides an estimate of blood sugar levels over several months). The second study surveyed nearly 600 physicians, and one-third said they thought their patients could benefit from exceeding treatment guideline goals. However this isn’t the case for older adults, in whom low blood sugar levels are associated with a small but significant increased risk of death, as well as a greater risk for confusion, falls, and hospitalizations. While the American Diabetic Association recommends an A1C goal of 7 percent in healthy adults, 8 percent is more realistic for frail older adults.

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