HbA1c shows average blood sugar over the past few months, but for older adults with diabetes, a low number is not always good. Targets should suit each person.
Two older people with the same type 2 diabetes and the same HbA1c of 6.3% may still be treated in two different ways. When the body carries many underlying conditions, is frail, has declining memory or is prone to low blood sugar, the goal is no longer to push HbA1c as low as possible.
What HbA1c tells you
This index reflects average blood sugar over the past few months, helping the doctor assess long-term control rather than relying on a single fasting blood test. But because it is an average, it does not show, over the course of a day:
- Whether blood sugar ever drops very low.
- Whether blood sugar spikes very high after meals.
- How much daytime and night-time levels differ.
- Whether low blood sugar occurs during sleep.
Someone whose blood sugar swings between high and low can still produce an average that looks perfectly fine, so the doctor always reads HbA1c together with other information.
Same age, different targets
Is an HbA1c of 6.2% at age 75 low or about right? Age alone cannot answer that. A 75-year-old who is still sharp, has few illnesses and looks after themselves is very different from someone of the same age who is frail, forgetful, has many conditions and takes many medicines. Roughly speaking:
- Still healthy, with few underlying conditions and good independence: the target may be below about 7-7.5%, as long as it can be reached safely without causing low blood sugar or too much burden.
- Many underlying conditions, frailty, or mild to moderate memory decline: a looser target may be acceptable, for example below about 8%.
- Very serious illness, end-stage disease, or depending on others for daily care: HbA1c is no longer the focus; what matters is that blood sugar does not drop too low and does not rise high enough to cause discomfort.
This framework is for reference only; the doctor also weighs heart disease, kidney disease, life expectancy, whether the person can manage their own medicines and the patient's wishes. The same 6.2% may be an excellent result for one person and a sign that treatment needs reviewing for another.
Do not cut back on medicine yourself when the numbers look good
Seeing a good HbA1c, some people immediately think about cutting down their injections on their own. This should not be done: reducing or stopping medicine yourself can make blood sugar rise quickly, and in patients who depend on injections, the wrong change can cause severely high blood sugar.
Before making any adjustment, the doctor needs a clear picture of the current medicines, blood sugar before and after meals, any night-time low blood sugar episodes, kidney function, meals, other medicines being taken, heart health and treatment goals. Reducing medicine is a doctor's decision, not a home care tip.
When HbA1c can be misleading
HbA1c is not perfect. Anything that changes the lifespan of red blood cells, such as anemia, recent blood loss or a blood transfusion, advanced kidney disease and certain hemoglobin disorders, can make the result drift away from reality. In those cases, direct blood sugar readings or data from a monitoring device add information, and an unexpectedly low HbA1c should be viewed in the context of the whole illness.
Questions families should ask the doctor
When a family member has a low HbA1c, especially if they use injections or take many medicines, you can ask the doctor:
- Given their current health, what range should HbA1c be kept in?
- Is the control tighter than necessary?
- Which medicines on the prescription can easily cause low blood sugar?
- Should blood sugar be checked during episodes of dizziness, sweating or falls?
- Is there a way to make treatment simpler while keeping it safe?
For older people, a good number must go hand in hand with safety, alertness and independence; the question worth asking is how that number was reached and what had to be traded off for it.
Trusted clinic for diabetes in older adults in Ho Chi Minh City
With nearly 20 years of experience and a team of highly qualified doctors, Ky Hoa Medical Center is a familiar choice for many families in Ho Chi Minh City when they need care for diabetes in older adults. Here, our Internal Medicine doctors take time to listen, examine carefully and explain clearly so that you fully understand your condition, then agree together on a treatment and follow-up plan.
Laboratory tests is performed on site, so you can complete check-ups in one place, which makes follow-up visits easier.
The center operates under Operating License No. 00449/HCM-GPHĐ, with a list of medical techniques approved by the Ho Chi Minh City Department of Health (Decision 471/QĐ-SYT), and is a primary care facility contracted with Ho Chi Minh City Social Security, accepting health insurance (BHYT) visits on Saturdays as well. The practising certificates of our 24 doctors are published on our Doctors page.
If a family member being treated for diabetes often feels dizzy, breaks into a sweat, falls or becomes confused, you can bring them to Ky Hoa Medical Center for an Internal Medicine consultation: simply walk in during opening hours and take a queue number. The doctor will review their results and order suitable laboratory tests.
Ky Hoa Medical Center
Address: 266A - 268 3 Thang 2 Street, Hoa Hung Ward, Ho Chi Minh City
Opening hours: Monday to Saturday, 6:30 - 11:30 and 13:00 - 17:00 (closed on Sunday)
Hotline: 028.3868.1097
Source: Suc Khoe & Doi Song (Health & Life) newspaper