How do you approach individualizing A1c goals in patients with dementia?

This is an important question for shared decision-making.

And it definitely is impacted by the severity/FAST staging of the dementia, as well as the class of medication use.

As we are all aware, we do not want to use the Sulfonylurea class in older adults, especially in patients with a dementia diagnosis, for the risk of hypoglycemia being even higher. Similar caution is required for long-acting Insulin.

For the MCI/mild dementia category, we do want to follow the usual recommendation of A1C goals as per comorbidities and frailty.

Especially since avoiding persistent hyperglycemia can help reduce the overall risk of dementia and dementia progression.

And uncontrolled hyperglycemia can also have a negative effect on dementia related behavior...

It's a question of time-to-benefit. As dementia typically has a 10-year life expectancy, with the later stages being functionally dependent, I often relax the Hgb A1c goal to 7.5-8%.

Other considerations are avoiding medications with risk for hypoglycemia, as noted in the above comment, while avoiding severe levels of hyperglycemia.