Are we risking older patients’ lives by putting too much emphasis on blood sugar control?
Key Takeaways
Industry Buzz
“[Blood sugar control] was really important when you were 50. Now, it’s less important." — Geriatrician Dr. Sei Lee, New York Times
Hypoglycemia is a significant risk for older adults with diabetes, but when it comes to managing A1C levels, how low is too low?
A normal A1C level is below 5.7%.[] For older patients, however, this "normal" level may actually be too low—something many of your patients may not realize. And while mild hypoglycemia is treatable, more serious instances come with grave consequences.[]
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Hypoglycemia requires immediate treatment to get blood sugar back to a healthy range.[] Signs and symptoms of more severe hypoglycemia can include confusion, unusual behavior or both, such as the inability to complete routine tasks; loss of coordination; slurred speech; blurry vision or tunnel vision; and nightmares.
In an interview with the New York Times, Dr. Sei Lee, a geriatrician at UCSF, noted that the health risks associated with hypoglycemia warrant allowing older patients' blood sugar to rise past 7%—and that maintaining levels below 7% "was really important when you were 50. Now, it’s less important,” she said.[]
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Diabetes care and A1C recommendations should be individualized for older adults.
The American Diabetes Association’s 2012 consensus report outlines individualized glycemic targets for older adults based on their overall health.[]
It recommends less aggressive A1C goals for patients with multiple medical conditions, cognitive impairment, or limited ability to manage daily activities—suggesting targets of <7.5% for healthy individuals, <8% for those with intermediate health, and <8.5% for those in poor health. Fasting and bedtime glucose levels are also adjusted accordingly.
The American Diabetes Association’s Standards of Care in Diabetes are updated at least yearly. For 2025, the guidelines summarize how A1C goals should be individualized according to the patient’s health, function, and other factors. []
Specifically, the Standards advise physicians to:
Select glycemic goals that avoid symptomatic hypoglycemia and hyperglycemia in all individuals.
Consider individuals’ resources and support systems to safely achieve glycemic goals.
Incorporate the preferences and goals of people with diabetes through shared decision-making.