Table 2.
Comparison of clinical recommendations for HbA1c goals in older patients with type 2 diabetes
| American Geriatrics Society68 | Department of Veterans Affairs69 | American Diabetes Association8 | European Diabetes Working Party for Older People9 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Description of patient stratum | HbA1c goal | Description of patient stratum | HbA1c goal | Description of patient stratum | HbA1c goal | Description of patient stratum | HbA1c goal | |||
| Healthy | 7.0-7.5% | None or very mild microvascular complications; life expectancy of 10-15 years | <7.0% | Healthy (few coexisting chronic illnesses; intact cognitive and functional status) | <7.5% | Without major comorbidities | 7.0-7.5% | |||
| Moderate comorbidities | 7.5-8.0% | Long duration of diabetes (>10 years); requires combination drug regimen including insulin | <8.0% | Complex/intermediate (examples: multiple coexisting chronic illnesses*, ≥2 instrumental ADL impairments, or mild-moderate cognitive impairment) | <8.0% | Frail patients (dependent; multi-system disease; care home residency, including those with dementia) | 7.6-8.5% | |||
| Multiple comorbidities | 8.0-9.0% | Advanced microvascular complications and/or major comorbid illness; life expectancy <5 years | 8.0-9.0% | Very complex/poor health (examples: long term care, end stage chronic illnesses†, moderate-severe cognitive impairment, or ≥2 ADL dependencies) | <8.5%‡ | |||||
ADL=activities of daily living.
*Conditions serious enough to require drugs or lifestyle management; may include arthritis, cancer, congestive heart failure, depression, emphysema, falls, hypertension, incontinence, stage 3 or worse chronic kidney disease, myocardial infarction, and stroke (multiple means ≥3, but many patients may have ≥5).
†Presence of single end stage chronic illness such as stages III-IV congestive heart failure or oxygen dependent lung disease, chronic kidney disease requiring dialysis, or uncontrolled metastatic cancer may cause considerable symptoms or impairment of functional status and significantly reduce life expectancy.
‡HbA1c of 8.5% equates to estimated average glucose of ~200 mg/dL; less strict glycemic targets than this may expose patients to acute risks from glycosuria, dehydration, hyperglycemic hyperosmolar syndrome, and poor would healing.