It's time to put the age' and the face' on HbA1c in elderly patients with diabetes mellitus
Gideon Mlawa1,3, James Alegbeleye1,3 & Raymond DEsouza1,2
Introduction: Older patients with diabetes mellitus often have concomitant comorbidities and physical disabilities which may lead to poor quality of life. The present diabetic guidelines available to clinicians in their practice suggest aggressive and meticulous diabetic control for target HbA1c (<7%). This is aimed at delaying or preventing complications. Such practice may predipose majority of older patients to experience recurrent hypoglycaemic epidodes and therefore compounding to their poor quality of life.
Methods: This is a cross-sectional survey of 46 diabetic patients aged between 65 and 90 years old who were seen in diabetic clinic. They were given questionnaire (SF36) to assess their quality of life (Mental and Physical component) in relation to blood glucose levels and other comorbidities.
Results: Older patients and especially those with other comorbidities such as chronic kidney disease, chronic obstructive airways disease, cognitive impairement, rheumatoid arthritis and peripheral vascular disease reported one or more episodes of hypoglycaemia per month due to tight glycaemic control. We found increased poor quality of life in such patients. Older patients responded that they were more likely to be less anxious and more comfortable if their blood glucose level was in the range of 710 mmol/l than below 5 mmol/l.
Conclusion: We suggest that clinicians practice should aim at supporting the well-being, good quality of life and healthy lifestyle of the older people with diabetes. Glycaemic control in this age group should be individualised to reflect patients clinical and personal needs and according to patients informed choice. By putting the age and the face on HbA1c both patients and clinicians will be able to achieve a better balance between good quality of life and acceptable glycaemic control.