Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is the most appropriate A1c target for a 69-year-old female patient with long-standing type 1 diabetes and multiple complications?

1. Less than 9.5%

2. Less than 8%

3. Less than 7%

4. Less than 6.5%

The correct answer is: Less than 8%

The most appropriate A1c target for a 69-year-old female patient with long-standing type 1 diabetes and multiple complications aligns with the recommended target of less than 8%. This target acknowledges the increased risk of hypoglycemia and potential adverse effects associated with more stringent A1c goals in older adults, particularly those with a history of diabetes-related complications. In patients with long-standing diabetes, especially older individuals, a more personalized approach is necessary. An A1c target under 8% serves to help manage blood glucose levels adequately while balancing the risks associated with intensive glucose-lowering strategies. Striving for excessively low targets—such as below 7% or 6.5%—could lead to severe hypoglycemia, detrimental to overall health and quality of life in this patient population. Setting the target at less than 9.5% would not be aggressive enough to provide a reasonable level of glycemic control, which is essential despite the presence of complications. Thus, less than 8% effectively represents a safe compromise between benefit and risk for this particular demographic of patients.