It is somewhat surprising that the ADA
has continued to promote guidelines for the elderly. At least they
admit that there are few long-term studies in older adults
demonstrating the benefits of intensive glycemic, blood pressure, and
lipid control. Patients who can be expected to live long enough to
reap the benefits of long-term intensive diabetes management, who
have good cognitive and physical function, and who choose to do so
via shared decision making may be treated using therapeutic
interventions and goals similar to those for younger adults with
diabetes. As with all diabetic patients, diabetes self-management
education and ongoing diabetes self-management support are vital
components of diabetes care for older adults and their caregivers.
I can accept this, but I admit I am
having trouble with the recommended levels for A1c goals as they say
for some that goals can be similar to those for younger adults with
diabetes. Then the tables used say the opposite with the minimum
upper level being an A1c of less than 7.5. To me this
one-size-fits-all guidance does seem very discriminatory and nothing
is mentioned about properly assessing and individualizing any
treatment when it comes to the elderly.
I do understand their fear of
hypoglycemia, but why are they not concerned about hyperglycemia. I
could guess they want people to develop complications, but as
doctors, why do they insist on doing harm to patients.
The above is not the full table and
below in the explanation for the 8.5%.
†A1C of
8.5% equates to an estimated average glucose of 200 mg/dl. Looser
glycemic targets than this may expose patients to acute risks from
glycosuria, dehydration, hyperglycemic hyperosmolar syndrome, and
poor wound healing.
This gives me some insight into why the Diabetes Clinic that I was using always wanted me to raise my A1c to the 7.5 to 8.0% level. Not that I will do this and I am no longer intending to return. My last A1c was higher that I like, but it will be back down by the next A1c in April and my eating habits are changing and my blood glucose levels are reflecting this.
This gives me some insight into why the Diabetes Clinic that I was using always wanted me to raise my A1c to the 7.5 to 8.0% level. Not that I will do this and I am no longer intending to return. My last A1c was higher that I like, but it will be back down by the next A1c in April and my eating habits are changing and my blood glucose levels are reflecting this.
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