Living with diabetes is increasingly common for older Americans, but there may be hidden downsides to the way it is currently treated, a new study suggests. Elderly patients whose clinicians target an A1c level below 7 percent may be at risk for hypoglycemia (dangerously low blood sugar), according to Dr. Kasia Lipska and her colleagues. They recently published a study in JAMA Internal Medicine in which they found people are treated in this way very often, and without regard to their additional health problems.
Lipska says people who are elderly and in poor health may increase their risk of hypoglycemic episodes, which can be very serious and even lead to death, if their treatment plan aims for the 7 percent marker or less. This is particularly a concern because older people have fewer warning signs of a hypoglycemic episode coming on, which can put them in danger from the condition itself and from other sources—for example, having an episode that leads to loss of consciousness while driving or cooking.
What should be done?
Lipska and her colleagues are not proposing new guidelines that raise ideal A1c levels for all patients. Rather, they wish to bring attention to the way treatment seems not to change much between demographics, even for those groups of people who could be seriously harmed by low blood sugar and intense treatment. Instead of using one guideline for all patients, the researchers recommend a strategy that will create a dialog between doctors and their patients. People who report frequent episodes of hypoglycemia, and who are elderly and in poor health, may need to have their diabetes care plans adjusted to account for their circumstances, rather than being told that a 7 percent A1c is everyone's ideal level. The researchers acknowledge this is a tall order.
Understanding your own treatment
If you are a senior with a complex medical history or serious ailments in addition to diabetes, you may want to keep careful track of whether you have hypoglycemic episodes and how often. This can be useful information for your doctor to have as the two of you work together to create a treatment plan that works for you. There are many factors in setting an A1c target and deciding how aggressively to treat diabetes, but it's important for you to be honest with your providers so everyone can make the most informed decisions possible.