The hemoglobin A1c (HbA1c) goal for a 78-year-old patient should be individualized based on several factors, including the patient's overall health, cognitive function, functional status, and presence of comorbidities.
General guidelines
- For many nonpregnant adult patients with diabetes, the American Diabetes Association (ADA) 2024 guidelines recommend an HbA1c goal of < 7% (< 53 mmol/mol)
- The American Academy of Family Physicians (AAFP) 2024 guidelines also recommend an HbA1c goal of < 7% for most nonpregnant patients aged < 65 years
Elderly patients
- For older patients with diabetes who are otherwise normal with few and stable coexisting chronic illnesses and intact cognitive function and functional status, the ADA 2024 guidelines recommend setting lower glycemic goals (HbA1c < 7.0–7.5%; 53–58 mmol/mol)
- For older patients with significant cognitive and/or functional limitations, frailty, severe comorbidities, and a less favorable risk-to-benefit ratio of diabetes medications, the ADA 2024 guidelines recommend less stringent goals (HbA1c < 8.0%; < 64 mmol/mol)
- The AAFP 2024 guidelines also suggest setting less stringent HbA1c goals for some patients aged ≥ 65 years with multiple comorbidities or a limited life expectancy
Considerations
- The ADA 2024 guidelines recommend assessing medical, psychological, functional (self-management abilities), and social domains in older adults to provide a framework to determine goals and therapeutic approaches for diabetes management
- Screening for geriatric syndromes (cognitive impairment, depression, urinary incontinence, falls, persistent pain, and frailty) and polypharmacy in older adults is also recommended, as they may affect diabetes self-management and diminish the quality of life
In conclusion, the HbA1c goal for a 78-year-old patient should be individualized, taking into account the patient's overall health, cognitive function, functional status, and presence of comorbidities. The goal may range from < 7% to < 8%, depending on these factors.