DEAR DR. ROACH: I am a 71-year-old male with Type 2 diabetes. My last A1C test showed a value of 7.8%. I have been taking Mounjaro weekly, which lowered my weight by about 20 pounds and my A1C level by about 0.5%. I also take diltiazem for hypertension, a statin, and one metformin pill per day. I read an article in the newspaper stating that according to experts, an A1C of over 7% may be appropriate for “older people.”

My question is, what is the definition of “older people”? Is it over 65 or even older? I am wondering if I still need to be overly concerned about my A1C reading. — A.

ANSWER: Although there are no clear studies to inform us of the ideal blood sugar control (the A1C is a measurement of your overall blood sugar during the past few months), expert groups try to balance the potential benefits of keeping sugar levels near normal (with its reduced risk of small blood vessel disease that can lead to kidney and nerve damage over time) against the potential harms from very tight blood sugar control (with its risk of dangerously low blood sugars).

Unfortunately, the term “older people” doesn’t really help here. The critical issue is whether a person is in sufficiently good health to realize the benefits of good blood pressure control. An otherwise healthy 71-year-old absolutely has a life expectancy that makes blood sugar control important, which means an A1C level of 7.0% to 7.5% might be ideal. For older people with multiple medical issues, an A1C of 8% might be reasonable.

Studies like the ACCORD trial, which showed that a very low A1C goal of 6% led to worse outcomes than an A1C goal of 7% in people at a high risk for heart disease, were done at a time when the medicines we had were not always good for the heart. The Mounjaro you are taking reduces the risk of heart disease, and future studies may show that this class of medicines, along with others like the SGLT2 inhibitors, may completely change our understanding of blood glucose control and heart disease. It may be that in the future, “tighter” control of blood sugar may lead to better long-term outcomes, but it will take large trials to help sort this out.

DEAR DR. ROACH: I have had a sore tongue for a month. I visited a doctor and got some ointment and mouthwash, but it hasn’t cured it. What other steps should I take? — G.W.

ANSWER: If you haven’t already, your first visit should be to a dentist who can do a comprehensive exam to look for other causes of tongue and mouth pain. Aphthous ulcers (“canker sores”), herpes virus (“cold sores”), dry mouth, allergic reactions and nutritional deficiencies are all possibilities. There are dermatologic diseases like a geographic tongue that can cause mouth or tongue pain. Fungal infections may also be the culprit.

Nerve diseases such as glossopharyngeal neuralgia and burning mouth syndrome could also cause symptoms. If your dentist and general physician haven’t been able to help, a visit with a neurologist may be of benefit.

I have had several patients become sensitive to sodium lauryl sulfate (SLS), which is an ingredient in many toothpastes. Occasionally, simply switching to an SLS-free toothpaste solves the problem.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.