Liberating A1C goals in older adults may not protect against the risk of hypoglycemia

Diabetes in Older People

“…This increased risk of hypoglycemia appears to be due to an age-related reduction in glucagon secretion, impaired awareness of hypoglycemic warning symptoms and altered psychomotor performance, which prevents the person from taking steps to treat hypoglycemia (55)(56)(57). Although it has been assumed that less stringent A1C targets may minimize the risks of hypoglycemia, a recent study using CGM suggests that older people with higher A1C levels still have frequent episodes of prolonged asymptomatic hypoglycemia (58). If these data are replicated in subsequent studies, the assumptions underlying higher A1C targets for functionally impaired people with diabetes will need to be revisited.…”

Increased Risk of Severe Hypoglycemic Events Before and After Cardiovascular Outcomes in TECOS Suggests an At-Risk Type 2 Diabetes Frail Patient Phenotype

“…This is particularly the case for patients experiencing severe hypoglycemic events (SHEs), with typically close to twice the risk of CV death in those who have experienced an SHE compared with those who have not. As a result, many diabetes management guidelines have been modified to advocate less aggressive glycemic targets to reduce the incidence of SHEs in the belief that this will minimize mortality risk (6,7), although less strict glycemic targets have not been shown to reduce the risk of SHEs (8). However, it remains unclear whether SHEs have a causal role in increasing CV mortality rates and whether more cautious glycemic targets, which may increase the risk of microvascular disease in the longer term (9), are warranted.…”

Management of Older People With Diabetes - A Focus On Mental Functions

“…Medications with less hypoglycaemic potential should be firstly chosen in these patients. Relaxing HbA1c targets in this group of patients may not be enough to reduce the risk of hypoglycaemia as continuous glucose monitoring has shown that asymptomatic hypoglycaemia is common regardless of HbA1c levels [70]. Monitoring of blood glucose has value in patients treated with insulin but not in those taking oral therapy [71].…”