Author Affiliations: Joslin Diabetes Center, Beth Israel, Deaconess Medical Center, Boston, Massachusetts.
Ali points out an important issue regarding the assessment of renal function in the care for older adults. In all patients with diabetes and renal dysfunction, dosages of oral hypoglycemic agents and insulin need to be adjusted to avoid hypoglycemia.
In our study, we did not observe any significant differences in renal function as measured by creatinine clearance between the groups with and without hypoglycemia (mean [SD] creatinine clearance, 83  mL/min vs 89  mL/min; P = .47). Thus, our results show increased risk of hypoglycemic episodes in older adults with poor glycemic control irrespective of their renal function.
Munshi MN. Hypoglycemia Associated With Impaired Renal Function—Reply. Arch Intern Med. 2011;171(16):1512. doi:10.1001/archinternmed.2011.379