Learning about Blood Sugar and Blood Pressure Goals in Elderly Patients with Type 2 Diabetes

Blood Sugar and Blood Pressure Goals in Elderly Patients with Type 2 Diabetes

diabetesAs people are living to a greater age, it is important to understand the differences in treating patients with diabetes in the geriatric population. Approximately 1 in 4 people over the age of 60 have a diagnosis of diabetes. Due to advances in health care these individuals are expected to have longer lifespans. It is imperative that diabetes management is well-maintained as these patients will be living with diabetes for potentially many years.

Diabetes is managed by aiming for specific A1C and fasting glucose goals. An A1C provides an estimate of the average blood sugar over a 3 month period. For most healthy, non-elderly patients with diabetes a goal A1C of < 7% is appropriate and fasting blood glucose goal is 80-130 mg/dL. An A1C of 7% corresponds to an estimated average glucose of 154 mg/dL over a 3 month period. However, some elderly patients are more prone to adverse effects and complications when strict control is implemented. Elderly individuals with diabetes are more likely to experience abnormally low blood sugar (hypoglycemia) from drug therapy. Older patients are also more at risk of falls and mental status changes such as confusion, particularly from low blood sugars and low blood pressure (hypotension). Therefore different goals are recommended in the elderly population and allow for higher average blood glucose levels and blood pressure.

In relatively healthy elderly patients with a long life expectancy, a reasonable A1C goal is < 7.5% and fasting glucose levels recommend between 90-130 mg/dL. In elderly patients with more complex medical issues and multiple chronic disease states, mild to moderate mental impairment, or are vulnerable to hypoglycemia or falls, a higher A1C goal of <8.0% is preferred. These patients have a recommended fasting glucose goal of 90-150 mg/dL. If an individual is in very poor health with severe chronic illnesses, requires long-term care, has poor mental status, and/or is expected to live for only a short time an A1C of < 8.5% and fasting blood glucose of 100-180 mg/dL is appropriate. The higher goals are due to a greater risk of dying from other conditions and hypoglycemia than from diabetes.
Since elderly patients are more prone to low blood pressure, blood pressure goals can be less strict as well. Low blood pressure can potentially be dangerous as it increases the risk of fainting and falls. Therefore the American Diabetes Association recommends a blood pressure goal of < 140/90 mmHg for older patients with diabetes and a higher blood pressure goal of < 150/90 mmHg is suitable in high-risk patients.

Treatment goals in patients with diabetes are not absolute and should be individualized to the patient. The goals above can act as a guideline for treating diabetes in a more fragile, older patient population. Low blood sugar and low blood pressure can be life-threatening and elderly patients with diabetes are less likely to benefit from strict glycemic and blood pressure control compared to their younger, healthier counterparts. By customizing care for elderly patients, we can avoid life-threatening events and better manage their diabetes.

This article is brought to you by our guest writers:
Jennifer Do, PharmD Candidate 2015 and
Jennifer D. Goldman, PharmD, CDE, BC-ADM, FCCP
Professor of Pharmacy Practice, School of Pharmacy Boston, MCPHS University
Clinical Pharmacist, Well Life, Peabody, MA

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