149-LB: Reluctant to Lose Control: Older Patients’ A1C Goals Lower than ADA Guidelines

Abstract

Older adults (≥65 years) represent >40% of patients living with diabetes. Multiple practice guidelines call for stratifying risk factor goals based on health status. “My Diabetes GOAL” is an intervention designed to introduce ADA guidelines to patients and to collaborate with them on setting glycemic goals. Participants ≥ 65 years, with type 2 DM, and an active patient portal account (MyChart) were randomized to a 6 month intervention (n=42) or delayed start control arm. Intervention patients completed a MyChart survey to elicit health status to identify ADA goals and initial self-reported A1C goals. A diabetes nurse spoke with patients to review and potentially revise goals. We compared patients’ 1) baseline A1C, 2) self-reported A1C and 3) revised A1C goals, versus ADA guidelines. Among 42 intervention patients, ADA A1C goals were <7.5% for 24, <8.0% for 13, and <8.5% for 5 patients. Most (35/42) patients self-reported an A1C goal, among whom 66% (23/35) self-reported A1C goals >0.5% lower than the ADA A1C goals. There were no statistically significant differences in baseline A1C, self-reported A1C, or revised A1C across patients with different ADA A1C goals (Figure 1). Older patients’ personal A1C goals were more aggressive than ADA guidelines and did not alter with nurse intervention. The results suggest that older patients with diabetes are anchored to lower A1C goals, and find more lenient A1C goals difficult to choose. Disclosure M. Cui: None. A. Nathan: None. C. Miles: None. V.G. Press: Consultant; Self; Humana, Vizient Inc. M. Pusinelli: None. M. Zhu: None. R. Ali: None. K. Scales: None. E. Huang: None.