Will Increasing Target A1C Goals Reduce Hypoglycemia Risk in Elderly Patients With T2D?

New research has concluded that hemoglobin A1c (HbA1c) levels are not linked to hypoglycemia risk in older, insulin-treated patients with type 2 diabetes.

This finding, according to researchers, suggests that higher A1c goals are not protective against hypoglycemia.

In the prospective study, researchers aimed to determine whether liberating A1c goals to decrease the risk for hypoglycemia in older patients, a strategy currently recommended by experts, is optimal for this purpose.

The study included 65 older patients (mean age, 76±6; 51% men) on insulin who received continuous glucose monitoring. At baseline, hypoglycemia duration and A1c were assessed while patients were on multiple insulin injections; measurements were again taken after de-intensification to once daily basal insulin with non-insulin agents.

Mean number of insulin injections per day was 3.7 (±1.3).

Baseline data indicated 26% of the patients had A1c <7% (53 mmol/mol); 42% were between 7.1% and 8% (54-64 mmol/mol); 21% were between 8.1% and 9% (65-75 mmol/mol); and 11% were >9% (76 mmol/mol).

No differences in hypoglycemia duration were reported among A1c groups, regardless of whether treatment consisted of multiple insulin injections or once daily basal insulin with non-insulin agents.

“[H]ypoglycemia risk is significant in the older population with type 2 diabetes on one or more insulin injections. Simply liberating A1C goals is inadequate for lowering the risk of hypoglycemia,” the researchers concluded.

“Lowering the complexity of the insulin regimen, use of [continuous glucose monitoring] to assess unrecognized hypoglycemia, and the use of agents with a lower risk of hypoglycemia are all good strategies to lower the risk of hypoglycemia in this frail population.”

Disclosures

The study was supported by an investigator-initiated grant from Sanofi. The researchers report no relevant financial disclosures.

References

Munshi MN, Slyne C, Segal AR, Saul N, Lyons C, Weinger K. Liberating A1C goals in older adults may not protect against the risk of hypoglycemia [published online March 16, 2017]. J Diabetes Complications. doi:10.1016/j.jdiacomp.2017.02.014