What’s My A1C Goal?
I am 82 years old. I’m really confused because I have always read that an A1C of 7 percent and below is the norm, but my doctor says that at my age 8 percent is OK. Meek C. Kiker Jr., Cantonment, Florida
Paris Roach, MD, responds
The prime directive in setting diabetes treatment goals and developing a treatment plan is to individualize therapy. One size does not fit all when it comes to A1C targets.
What to Know
In general, we think about an A1C of less than 7 percent as a starting point. We then consider whether or not the target should be higher or lower based on a person’s individual situation. Younger people have more to gain from tight control because they have decades of diabetes ahead of them and therefore more time to develop complications. Additionally, they usually have fewer health conditions, such as heart disease, that might make more aggressive treatment risky. A1C targets for younger individuals may be 6.5 or even 6 percent—if they can be reached safely. Those with frequent low blood glucose and with poor warning symptoms of lows may need to have higher A1C goals.
With respect to older individuals, there is evidence that too-tight glucose control is associated with a greater risk for early death, including death from cardiovascular disease. Tight control in this age group, as in others, is associated with an increased risk of hypoglycemia, which can lead to falls and injuries. Older people may not sense hypoglycemia as easily.
Because complications take years to develop, older adults may not experience the long-term benefits of tight glucose control, and these risks may therefore be justified. Prevention of short-term complications of high blood glucose such as fatigue, blurry vision, and dehydration can be achieved with higher A1C targets.
Find Out More
These considerations have led some professional organizations, including the American Diabetes Association, to recommend higher A1C targets in older individuals: up to 7.5 percent for healthy people to as high as 8.5 percent for those who are ill.
Only you and your care provider can determine a safe target based on your risks for short- and long-term complications of diabetes versus the risks associated with various levels of glucose control and the treatments used to achieve them.
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