Rita H. Khoury, MD; B. P. Salmon, MS; Asha Gandhi, BS; Peter Gudaitis, BA; Dauna Gudaitis, BA

(2015) Abstracts and Case Studies From the College of American Pathologists 2015 Annual Meeting (CAP ’15). Archives of Pathology & Laboratory Medicine: October 2015, Vol. 139, No. 10, pp. e2-e186.

Context: More than 25% of people age 65 and older in the United States have diabetes, and almost one-third are unaware that they have the disease. The first step in diabetes care is glycemic control to prevent the acute complications and reduce the risk of long-term complications; the American Diabetes Association has recommended A1c <7% as an indicator for tight glycemic control.

Design: Specimens from 13 974 patients resident in long-term care facilities for A1c and glucose were collected. Glucose and A1c were done using Roche Integra 800 (Roche Diagnostic, Indianapolis, Indiana); A1c assay was standardized according to IFCC transferable to DCCT/NGSP. Patients’ data were separated into 6 age groups: <50, 51–60, 61–70, 71–80, 81–90, and >90 years old. The prevalence of glucose <75 mg/dL was calculated at A1c <7.0%, <7.5%, and <8% for all age groups. Statistical analysis was done using Analyse-it.

Results: Of the patients 66.0% had A1c <7% and 16.3% had A1c >8%. There was a negative correlation between A1c and glucose <75 mg/dL across all ages; the groups with lower A1c have the highest percentage of patients with hypoglycemia.

Conclusions: This study suggests that diabetes is well monitored in LTCF; two-thirds of the patients have met the recommended goal for geriatric glycemic control. Hypoglycemia is more common in patients with A1c <7%; physicians should follow the American Diabetes Association and the American Geriatric Association recommendation and endorsement for higher glycemic target for the older diabetic patients to avoid hypoglycemia and its consequences.