Normal blood glucose levels in older adults
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Normal Blood Glucose Levels in Older Adults: Key Insights
Age-Related Changes in Blood Glucose Levels
Blood glucose levels tend to increase with age, even in adults without diabetes. Studies show that the blood glucose level associated with the lowest mortality risk also rises as people get older, suggesting that what is considered "normal" may shift upward with age. This change is partly due to the body's declining ability to handle stress and maintain glucose stability as it ages 48.
Fasting Blood Glucose Ranges and Health Outcomes
For older adults, especially those with diabetes, the optimal fasting blood glucose range for the lowest risk of death and cardiovascular events is higher than in younger adults. Research in older adults with diabetes found that fasting glucose levels between 110–124 mg/dL are linked to the lowest mortality, and 95–124 mg/dL to the lowest cardiovascular risk. Notably, having fasting glucose below 95 mg/dL may actually increase cardiovascular risk, especially in those with multiple health problems 39.
Clinical Guidelines and Individualization
Current clinical guidelines recommend a target blood glucose range of 140–180 mg/dL (7.8–10 mmol/L) for most hospitalized older adults, both in ICU and non-ICU settings. However, these targets should be individualized based on the person's overall health, risk of low blood sugar (hypoglycemia), and presence of diabetes complications. For outpatient management, less stringent targets may be safer and more appropriate for frail or complex older adults 15.
Continuous Glucose Monitoring and Time in Range
Continuous glucose monitoring (CGM) is increasingly used in older adults with diabetes. The recommended "time in range" (TIR) for glucose is 70–180 mg/dL (3.9–10 mmol/L). Most healthy older adults with diabetes can achieve these targets, but those with more complex health issues may need more relaxed goals to avoid hypoglycemia. Avoiding low blood sugar is especially important, as older adults are more vulnerable to its harmful effects 57.
Normal Fasting Glucose and Prediabetes in Older Adults
In community studies, many older adults have fasting glucose in the "prediabetes" range (100–125 mg/dL), but only a small percentage progress to diabetes over several years. In fact, many revert to normal glucose levels or die from other causes before developing diabetes, suggesting that prediabetes may not be as meaningful a diagnosis in older age as it is in younger people .
Blood Glucose and Other Health Risks
Even within the normal fasting glucose range, higher values are linked to a greater risk of hypertension in older adults. This means that while slightly higher glucose may be normal with age, it can still be associated with other health risks, and regular monitoring remains important .
Conclusion
Normal blood glucose levels in older adults are generally higher than in younger adults, and the optimal range for minimizing health risks shifts upward with age. For most older adults, especially those with diabetes or multiple health conditions, fasting glucose levels between 95–124 mg/dL are associated with the best outcomes. Clinical targets should be individualized, with a focus on avoiding hypoglycemia and considering the person's overall health status. Regular monitoring and flexible targets are key to safe and effective blood glucose management in older adults 13458910.
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