What are the blood glucose targets for elderly people with type 2 diabetes?

Blood glucose targets for elderly people with type 2 diabetes are generally the same as other adults with type 2 diabetes. (The term ‘elderly’ generally refers to people who are over 65 years of age.)

In fact, the Diabetes Canada clinical practice guidelines recommend that otherwise healthy elderly people with diabetes – whether they have type 1 or type 2 – should also be treated to achieve the same blood pressure and cholesterol targets as younger people with diabetes.

Blood glucose and A1C targets for adults and elderly people with diabetes

The recommended blood glucose and A1C targets for adults with diabetes are as follows:

• Fasting blood glucose (blood glucose before a meal): 4.0 to 7.0 mmol/L
• Blood glucose two hours after eating a meal: 5.0 to 10.0 mmol/L (or 5.0 to 8.0 mmol/L if your A1C targets are not being met)
• A1C: 7.0% or lower

Blood glucose and A1C targets for frail elderly people

The Diabetes Canada clinical practice guidelines were recently updated to recommend different blood glucose targets in the “frail elderly.” These are seniors who have three or more of the following conditions:

• Unintended weight loss of more than 4.5 kilograms (10 pounds) during the past year
• Constant fatigue or exhaustion
• Weakness in their arms and legs
• A slow walking speed
• Low levels of physical activity

In these people, the A1C target is ≤8.5% (vs. <7.0% in the general population), and pre-meal (fasting) blood sugar levels should be 5.0 to 12.0 mmol/L (vs. 5.0 to 10.0 mmol/Lin the general population).

One of the main reasons why blood sugar and A1C targets are higher for frail elderly people is that studies have shown that tighter blood sugar control is associated with mortality in this population. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study – a very large trial of more than 10,000 adults with type 2 diabetes – found that very tight glycemic control in older patients was associated with an increased risk of death.

As well, frail elderly adults are more inclined to suffer from moderate to severe hypoglycemia. This is because they may not be eating a nutritionally balanced diet; they are also more likely to have other ailments for which they take medications that may contribute to episodes of hypoglycemia.

Elderly people and diabetes medications

Due to the increased risk of hypoglycemia in elderly people, the Diabetes Canada clinical practice guidelines recommend the following with respect to medications used to treat diabetes:

• The class of drugs known as sulphonylureas are generally not recommended, as they can cause severe hypoglycemia.
• Insulin detemir (Levemir) and insulin glargine (Lantus) should be used instead of NPH or human 30/70 insulin.
• For people who need a mixture of insulin, premixed insulins and prefilled insulin pens are recommended, which can help reduce the risk of dosing errors and therefore help prevent hypoglycemia.