Answer 1 is incorrect. 3.76% chose this answer. “TS’s A1c is not at target of less than 7%, recommend behavior modifications and work to improve medication adherence.” Answer 1 is incorrect. The American Diabetes Association 2024 Standards of Care recommends personalizing glycemic targets for adults over 65 depending on comorbidities, cognitive and functional status, and living situations. An A1c of less than 7% may not be appropriate. 

Answer 2 is incorrect. 19.95% of you chose this answer. “A1c targets should be liberalized to less than 8% for all older adults to reduce hypoglycemia risk.” Answer 2 is incorrect. While it is true we may liberalize A1c targets for older adults to prevent hypoglycemia, it is not the best answer. Older adults over 65 who are otherwise healthy, have stable coexisting chronic conditions, and have intact functional and cognitive status may benefit from lower glycemic goals (less than 7 to less than 7.5%). 

Answer 3 is correct. About 61.74% of respondents chose this. “Assess TS’s comorbidities, cognitive function, and life expectancy before providing additional recommendations.” Answer 3 is the correct action. In older adults with diabetes, assessing comorbidities, cognitive function, and life expectancy is important to allow for the personalization of diabetes management recommendations and care goals.

Finally, Answer 4 is incorrect. 14.55% chose this answer. “Recommend increased family involvement in TS’s daily diabetes medication management due to missed insulin doses and change in diet intake.” Answer 4 is incorrect. We need more information to conclude that TS needs additional family support today. Completing a comprehensive evaluation, including cognitive function screening, is essential before providing recommendations. 

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!