What should A1C be for older adults? It depends on overall health, not age alone. The American Diabetes Association's 2026 guidance suggests goals such as an A1C below 7.0–7.5% for healthy older adults and below 8.0% for those with complex health. In very poor health, ADA advises against relying on A1C and focusing on avoiding lows and high blood sugar that causes symptoms.
Key takeaways
- A1C goals for older adults are treatment targets, not diagnosis levels. They depend on overall health, not age alone.
- ADA 2026 suggests goals such as an A1C below 7.0–7.5% for healthy older adults and below 8.0% for those with complex or intermediate health.
- In very complex or poor health, ADA advises against relying on A1C. Avoiding lows and high blood sugar that causes symptoms comes first.
- ADA allows a lower goal if it can be reached without repeated or severe lows or undue treatment burden.
- A1C can be inaccurate with kidney failure, recent significant blood loss, blood transfusions, or erythropoietin therapy. Glucose checks or a continuous glucose monitor (CGM) can be used instead.
Why Isn't There One A1C Goal for Every Older Adult?
A1C reflects average blood glucose over about two to three months, according to the American Diabetes Association's Standards of Care in Diabetes—2026, Section 6. For older adults, the right goal depends on health and goals of care, not birthdays.
ADA Section 13 explains the reasoning. The benefits of lowering glucose build up over years. Based on what ADA calls "competing mortality and time to benefit," people with shorter life expectancy, advanced diabetes complications, life-limiting illnesses, frailty, or major memory or physical limitations get less benefit from lowering glucose and should have less strict goals. They are also more likely to have serious side effects of treatment, such as low blood sugar (hypoglycemia).
Trial results support caution. ADA cites the ACCORD and VADT trials, in which intensive treatment aimed at an A1C below 6.0% with complex drug plans significantly increased the risk of lows that needed another person's help. ADA also notes that those plans relied heavily on insulin, used few GLP-1 receptor agonists, and came before SGLT2 inhibitors were available.
The other side matters too. ADA says older adults who are expected to live long enough to benefit, who have good thinking and physical function, and who find treatment manageable may use goals similar to those for younger adults.
A1C goals are different from the A1C levels used to diagnose diabetes. If you want to know what a result means for diagnosis, see what A1C is considered diabetic.
What A1C Goals Does ADA 2026 Suggest?
ADA's consensus framework (Table 13.2 in Section 13) groups older adults by overall health. These are examples. Your clinician sets your goal.
| Health status (ADA 2026) | Reasonable A1C goal | Fasting or before-meal glucose | Bedtime glucose |
|---|---|---|---|
| Healthy: few other chronic illnesses, intact thinking and daily function | Below 7.0–7.5% | 80–130 mg/dL | 80–180 mg/dL |
| Complex or intermediate: several chronic illnesses, needing help with daily activities, or mild to moderate cognitive impairment | Below 8.0% | 90–150 mg/dL | 100–180 mg/dL |
| Very complex or poor health: long-term care, end-stage illness, moderate to severe cognitive impairment, or needing help with daily activities | Avoid relying on A1C; focus on avoiding lows and high blood sugar that causes symptoms | 100–180 mg/dL | 110–200 mg/dL |
A footnote to the table says a lower A1C goal may be set if it can be reached without repeated or severe lows or undue treatment burden. ADA also notes that the categories are general concepts. Not every person fits neatly into one, and health and preferences can change over time.
Which Health Group Fits You?
ADA describes the three groups this way:
- Healthy: few coexisting chronic illnesses, with intact thinking and daily function.
- Complex or intermediate: multiple coexisting chronic illnesses (ADA means at least three), needing help with daily activities, or mild to moderate cognitive impairment. ADA's examples of chronic illnesses include arthritis, cancer, heart failure, depression, emphysema, falls, high blood pressure, incontinence, stage 3 or worse chronic kidney disease, heart attack, and stroke.
- Very complex or poor health: living in post-acute or long-term care, an end-stage illness, moderate to severe cognitive impairment, or needing help with daily activities. ADA's end-stage examples include stage 3–4 heart failure, oxygen-dependent lung disease, kidney disease requiring dialysis, and uncontrolled metastatic cancer.
ADA says the person's preferences, the care partner's preferences and involvement, abilities, and resources are part of choosing goals. Ask your clinician which group they think fits you and why. Bring a family member if that helps.
What Are CGM Goals for Older Adults?
If you use a CGM, goals can be set as time in range (70–180 mg/dL) and time below range. ADA 2026 recommendations 13.7a and 13.7b give these examples:
| Health status (ADA 2026) | Time in range (70–180 mg/dL) | Time below 70 mg/dL |
|---|---|---|
| Healthy | 70% or more | 4% or less |
| Complex or intermediate | 50% or more | Less than 1% |
ADA Section 6 puts the complex-health goals in hours: 50% time in range is about 12 hours a day, and time below 70 mg/dL should be no more than about 15 minutes a day. ADA recommendation 6.3c says therapy should be reduced or changed if time-below-range goals are not met. That decision belongs to your clinician.
ADA recommendation 13.5 recommends a CGM for older adults with type 1 diabetes and for older adults with type 2 diabetes who take insulin.
When Can A1C Be Misleading?
ADA notes that A1C results may be inaccurate in people who have had blood transfusions or who have conditions that affect red blood cell turnover. Conditions like this that are common in older adults include kidney failure, recent significant blood loss, and erythropoietin therapy.
In those cases, ADA says blood glucose monitoring or a CGM should be used for setting goals. A blood test called fructosamine may also help, alongside other measures.
To see what an A1C result means in everyday glucose numbers, try our A1C to blood sugar chart.
Does a Less Strict Goal Mean High Blood Sugar Is OK?
No. ADA says significant high blood sugar should be avoided even with complex health. Glucose above 180 mg/dL raises the risk of dehydration, weakness, infection, poor wound healing, and hyperglycemic crises, and ADA says goals should, at a minimum, avoid these problems.
A less strict goal is about avoiding harm from treatment, not about ignoring high readings. For readings that need urgent attention, see what a dangerous blood sugar level is. If you are sick, our diabetes sick day rules explain what to ask your care team.
What If Your A1C Is Below Your Goal?
A lower number is not always better for an older adult. ADA allows a lower goal only when it can be reached without repeated or severe lows or undue treatment burden.
ADA recommendation 13.4 says lows should be asked about and addressed at routine visits, because older adults have a greater risk, especially with insulin, sulfonylureas, or meglitinides. For people at high risk of lows, recommendation 13.14a says these medicines should be reduced, or switched to a class with a low risk of lows.
If your A1C is well below your goal, or you have had lows, ask whether your plan still fits. Do not stop or change a medicine on your own. Our guide to low blood sugar in older adults explains warning signs and prevention.
How Often Should Older Adults Check A1C?
ADA recommendation 6.2 says to check glucose status at least twice a year. It suggests checking more often, such as every three months, for people who are not meeting goals or have had recent treatment changes, frequent or severe lows or highs, or a change in health.
Our list of diabetes tests you may need each year shows how A1C fits with other checks. A daily type 2 diabetes checklist can help you keep track of glucose checks and lows to bring to your next visit.
What Should You Ask About Your A1C Goal?
Bring these questions to your next visit:
- Which health group do you think fits me, and why?
- What A1C goal, or CGM goal, fits me now?
- Is A1C accurate for me, given my kidneys, blood counts, or other conditions?
- Have I had lows, including ones I may not have noticed?
- Could any part of my treatment plan be simpler?
- When should we review my goal again?
For a broader look at care after 65, see our guide on how to manage diabetes in older adults. Our appointment preparation checklist can help you organize notes.
When Should You Get Help?
Emergency: Call 911 if someone with diabetes is unconscious, having a seizure, cannot swallow, or is getting worse despite following their low plan.
Same day: Contact your care team the same day after any low that needed someone else's help, if lows keep happening, or if you are sick and cannot keep food or fluids down.
Prompt appointment: Book a visit if your A1C or CGM results are well above or below your goal, if you have a new health problem or a recent hospital stay, or if your treatment plan has become hard to manage.
Frequently Asked Questions
What is a good A1C for a 75-year-old?
There is no single number for every 75-year-old. ADA 2026 bases goals on overall health: such as an A1C below 7.0–7.5% for healthy older adults, below 8.0% for those with complex or intermediate health, and no reliance on A1C in very poor health. Your clinician sets your goal.
Is an A1C of 8 OK for an older adult?
It depends on health. ADA 2026 suggests an A1C below 8.0% as a reasonable goal for older adults with complex or intermediate health, and lower goals, such as below 7.0–7.5%, for healthy older adults. Your clinician can tell you whether your result fits your plan.
Why are A1C goals less strict for some older adults?
The benefits of lowering glucose take years to build up, while the risk of serious low blood sugar is higher with frailty, memory problems, or serious illness. ADA 2026 says people in these groups get less benefit from lowering glucose and should have less strict goals, while still avoiding very high blood sugar.
Can A1C be wrong in older adults?
Yes. ADA 2026 notes that A1C may be inaccurate after blood transfusions and with conditions that affect red blood cells, such as kidney failure, recent significant blood loss, or erythropoietin therapy. In those cases, glucose checks or a continuous glucose monitor should guide goals, and a fructosamine test may also help.
What are CGM goals for older adults?
ADA 2026 suggests at least 70% time in range (70 to 180 mg/dL) with 4% or less time below 70 mg/dL for healthy older adults. For complex or intermediate health, it suggests at least 50% time in range with less than 1% time below 70 mg/dL.
Should older adults aim for an A1C below 7%?
Some healthy older adults may. ADA 2026 suggests goals such as below 7.0–7.5% for healthy older adults and allows a lower goal if it can be reached without repeated or severe lows or undue treatment burden. For people with complex health, ADA advises less strict goals.
References
- American Diabetes Association Professional Practice Committee for Diabetes. “13. Older Adults: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1):S277–S296. Accessed October 2026.
- American Diabetes Association Professional Practice Committee for Diabetes. “6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1):S132–S149. Accessed October 2026.
- Aristotle. Nicomachean Ethics, Book II, translated by W. D. Ross. The Internet Classics Archive. Historical context only for the companion feature. Accessed October 2026.
Next Steps
Ask your clinician which health group fits you, what A1C or CGM goal fits you now, and whether your A1C is accurate for you. Bring a list of any recent lows.
For adults with type 2 diabetes or prediabetes who want lifestyle education alongside clinical care, the Done With Diabetes™ program offers a natural protocol for type 2 diabetes that organizes learning about meals, movement, sleep, and stress. It does not diagnose or treat diabetes, set A1C goals, interpret test results, change medicines, or replace your care team.