A Taiwanese kidney doctor highlights a large British study revealing optimal blood sugar levels for older diabetics, cautioning against overly aggressive glucose control due to increased risks of hypoglycaemia and dementia.
A Taiwanese kidney doctor has warned that, for older adults with type 2 diabetes, blood sugar that is pushed too low can be just as worrying as high readings. In a Facebook post and on his website, Lin Xuanren pointed to a large British database study of more than 27,000 people aged 50 and above, followed for more than 20 years, which found the lowest death risk at an HbA1c of 7.5%. HbA1c is the measure of average blood glucose over about three months.
According to the study published in the Journal of Clinical Endocrinology & Metabolism, people in the lowest HbA1c group, with an average of 6.4%, had a 52% higher death risk than those around the 7.5% mark, while the highest group, averaging 10.5%, had a 79% higher risk. The findings support a more cautious approach in older patients, where avoiding hypoglycaemia may matter more than driving glucose ever lower.
Lin also highlighted the danger of “hypoglycaemia unawareness”, a condition in which the warning signs of low blood sugar become muted. He said older people may not get the early signals younger patients often notice, such as hunger, trembling or anxiety, and can instead move straight to confusion, falls, seizures or loss of consciousness. He warned that a serious episode can lead to lasting harm, particularly after a hip fracture.
That concern is echoed by a separate US cohort study of more than 16,000 people with diabetes, average age 65, which found that severe hypoglycaemia was linked to a 1.68-fold higher dementia risk over 27 years. The risk rose with repeated episodes: one severe event was associated with a 1.45-fold increase, two events with 2.15 times the risk, and three or more with 2.80 times the risk. Lin said this is why treatment targets for older adults should be based less on age alone and more on overall health, independence and the risk of treatment side effects.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
