Because the long-term benefits
of intensive glycemic control may not appear for 6 to
8 years, a relaxed target may also be appropriate for individuals
with limited life expectancy. The European Diabetes
Working Party also established an HbA1c goal of
7.5% to 8.5% for frail residents in long-term care facilities.
13 Data from a retrospective cohort study, which
showed that an HbA1c of 7.5% was associated with lower
mortality rates than in individuals with lower or higher
HbA1c levels also support a slightly higher goal,14
although the therapeutic goal of glycemic control is not
only to reduce mortality but also to reduce the complications
and symptoms of hyperglycemia with minimal hypoglycemia.
Still, recent data suggest that hypoglycemia can
be frequent even in elderly adults with poor glycemic control
and higher HbA1c levels, suggesting that raising
HbA1c goals may not be enough to prevent hypoglycemia