Glycemic Control in Older Adults: Applying Recent Evidence to Clinical Practice

Ajay Sood, MD; David C. Aron, MD, MS

Disclosures

Geriatrics and Aging. 2009;12(3):130-134. 

In This Article

Abstract and Introduction

Abstract

Glycemic goals and the decision to intensify glycemic control among older adults with diabetes must be individualized based on comorbid conditions and the risks associated with treatment. The duration of diabetes mellitus, baseline glycosylated hemoglobin value, prior history of cardiovascular disease, and history of severe hypoglycemia are important factors to consider. This article reviews how the management of diabetes mellitus in this subgroup is changing in view of three recently reported randomized trials of intensive glycemic control.

Introduction

Diabetes mellitus (DM) is a serious concern among older adults,[1] and its occurrence has increased both with the aging of the population as well as a rise in the prevalence of DM.[2] It has been pointed out in several articles that the approach to treatment of hyperglycemia in older adults is different from that in younger people with DM.[3,4,5] In 2003, the California Health Foundation and the American Geriatrics Association published guidelines for the care of older adults with DM6 that focused on individualizing care for each patient, especially in terms of glycemic control targets. The issue of glycemic control in general has been brought to the forefront by three recently reported randomized controlled trials: Action to Control Cardiovascular Risk in Diabetes (ACCORD),[7] Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE),[8] and the Veteran Affairs Diabetes Trial (VADT).[9] The results from these trials are reshaping our thinking of how we should treat older adults with diabetes, especially the oldest adults. However, the fundamentals of clinical decision making remain the same: balance the risks and benefits for the individual patient.

This article reviews how management strategies in older adults with DM should differ from those in younger patients, and how the results of the above studies can impact our practice.

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