HbA1c trend analysis in the Management of type 2 diabetes mellitus among elderly patients with diabetes

Roisin Nolan; A. Nolan; N. Kelly

doi:10.5281/zenodo.22812596

Authors

Roisin Nolan Department of Diabetes and Endocrinology, Parana Institute for Advanced Metabolic Disease Author https://orcid.org/7320-2259-3794-6520
A. Nolan Department of Diabetes and Endocrinology, Rhine Academy of Metabolic Disease Author https://orcid.org/2219-0148-6699-2611
N. Kelly Department of Diabetes and Endocrinology, Yukon Center for Metabolic Disease Author https://orcid.org/5156-7373-5312-0998

DOI:

https://doi.org/10.5281/zenodo.22812596

Keywords:

HbA1c, type 2 diabetes mellitus, elderly patients, glycaemic control, hypoglycaemia

Abstract

Graphical abstract

Background: Glycated haemoglobin (HbA1c) guides long-term glycaemic management in type 2 diabetes, yet its interpretation in elderly patients is complicated by comorbidity, frailty, and an elevated hypoglycaemia risk that changes the calculus of tight control [28,2].

Objective: This review analyzes longitudinal HbA1c trend as a management tool in elderly patients with type 2 diabetes, and how individualized targets should be set across the spectrum of functional status.

Methods: We synthesized landmark randomized trials of glycaemic control, long-term cohorts, and geriatric-focused guidelines addressing HbA1c targets and hypoglycaemia risk in older adults.

Findings: Intensive control reduces microvascular complications but shows an inconsistent, sometimes harmful, effect on mortality in older, comorbid populations [13,14,15], while a legacy effect from earlier tight control persists for decades [9,10]; hypoglycaemia risk rises sharply with age and frailty [6,19,22].

Conclusions: HbA1c trend, interpreted alongside functional status and hypoglycaemia history rather than as an isolated threshold, supports individualized targets from roughly 7.0-7.5% in healthy older adults to 8.0-8.5% in frail patients [7,29].

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