January 2, 2015

The ADA on Older Adults, 2015

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.

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