What factors point against intensive blood glucose lowering in type 2 diabetes mellitus (DM)?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

Factors that can produce an unfavorable risk-benefit ratio for intensive blood glucose lowering include advanced age, other major systemic disease, and advanced microvascular and neuropathic complications. For example, in an elderly patient, risk considerations may include the possibility of falling and breaking a hip during a hypoglycemic episode.

In elderly patients who have a life expectancy of less than 5 years or in any patient with a terminal disease, tight control may be unnecessary. Patients with cardiovascular or cerebrovascular disease may also need higher preprandial blood glucose targets (eg, 100-150 mg/dL) to prevent severe hypoglycemia.


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