Treatment goals for type 2 diabetes should always be set individually. In practice, this mainly involves an indicator of the success of long-term compensation – glycated hemoglobin (HbA1c). Recommendations for the diagnosis and treatment of diabetes for general practitioners from 2020 list different target HbA1c values according to the risk of hypoglycemia and other parameters. They also recall different target values for fit, frail, and dependent seniors.
The risk of hypoglycemia in type 2 diabetics increases with the treatment of insulin and sulfonylurea derivatives, advanced age, duration of diabetes, liver and kidney insufficiency, irregular eating or physical exertion, malnutrition (e.g., in oncological diseases), alcohol consumption, cognitive impairment, or depression. Clinical studies show that the patient’s individual target HbA1c value should be derived from their risk of hypoglycemia.
Table 1 Target HbA1c values based on the risk of hypoglycemia in type 2 diabetics
Risk of hypoglycemia
Target HbA1c value
low
≤ 45 mmol/mol
medium
≤ 53 mmol/mol
high
54–60 mmol/mol
frail patients
around 70 mmol/mol
Less strict glycemic compensation (i.e., higher target HbA1c value) is suitable not only for patients with a higher risk of hypoglycemia but also for less motivated, non-cooperative, and non-self-sufficient patients, with long-term diabetes, short life expectancy, significant comorbidities, and severe vascular complications of diabetes.
For older patients with type 2 diabetes, a compromise should be sought between the risk of progression of microvascular and macrovascular complications of diabetes and the risk of hypoglycemia when choosing the target glycemic compensation.
Table 2 Target HbA1c values in diabetic seniors
Type of patient
Characteristics
fit seniors
cooperative, motivated, with low risk of adverse events, with short-term diabetes, without cardiovascular complications, without hypoglycemia
frail seniors
with severe comorbidities, limited life prognosis, limited self-sufficiency
≤ 60 mmol/mol
dependent seniors
non-self-sufficient, immobile, with severe hypoglycemia in history, very poor life prognosis, with advanced complications and comorbidities, non-cooperative
≤ 70 mmol/mol
In frail older patients, we often encounter conditions or situations where HbA1c value is not a suitable indicator of compensation. In such cases, according to SVL ČLS JEP recommendations, we focus on random blood glucose levels in the range of 6.7–11.1 mmol/l instead of target HbA1c values.
(zza)
Sources: 1. Karen I., Svačina Š. Diabetes mellitus. Novelizace 2020. Recommended diagnostic and therapeutic procedures for general practitioners. Society of General Medicine ČLS JEP, 2020. Available at: www.svl.cz/files/files/Doporucene-postupy/2020/DIABETES-MELLITUS-2020.pdf 2. Karen I., Svačina Š., Jurašková B. Diabetes mellitus. Treatment in elderly patients in the Czech Republic. Novelizace 2019. Society of General Medicine ČLS JEP, 2019. Available at: www.svl.cz/files/files/Doporucene-postupy/2017/DM-u-starsich-pac-2019.pdf
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.
Don‘t have an account? Create new account
Enter the email address that you registered with. We will send you instructions on how to set a new password.
