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Status
Available –  clinician or patient version

Description
Intensive A1c therapy may lead to a high risk of hypoglycemia.

An A1c of 7% is not right for everybody with Type 2 diabetes. Too low of an A1c increases the risk for hypoglycemia (low blood sugar) in certain patients with diabetes. Hypoglycemia leads to falls and fractures, head injuries, long-term care placements and hospital admissions, especially in patients  ≥75 years, on intensive glucose – lowering treatment, taking sulfonylureas or insulin, or those with multiple chronic conditions.

References

1. Lee AK, Juraschek SP, Windham BG, et al. Severe hypoglycemia and risk of falls in type 2 diabetes: the atherosclerosis risk in communities (Aric) study. Diabetes Care. 2020;43(9):2060-2065.

2. Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med. 2015;175(3):356.

3. McCoy RG, Lipska KJ, Van Houten HK, Shah ND. Association of cumulative multimorbidity, glycemic control, and medication use with hypoglycemia-related emergency department visits and hospitalizations among adults with diabetes. JAMA Netw Open. 2020;3(1):e1919099.

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