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April 6, 2011

Goals of Glycemic Control in Frail Older Patients With Diabetes

Author Affiliations

Author Affiliations: San Francisco VA Medical Center and University of California, San Francisco, Division of Geriatrics (Dr Lee); and On Lok Lifeways, San Francisco (Dr Eng).

JAMA. 2011;305(13):1350-1351. doi:10.1001/jama.2011.404

More than 40% of adults with diabetes in the United States are older than 65 years,1 and many of these older individuals are frail with functional deficits that limit their ability to live independently.2 In 2004, an estimated 324 000 Americans with diabetes were living in nursing homes,3 and a similar number of frail older persons with diabetes who qualified for nursing home care lived in the community through formal and informal caregiver support.4 However, large randomized trials that examined the effect of glycemic control on outcomes generally have excluded frail older persons. The limited evidence base has led to considerable uncertainty regarding the appropriate level of glycemic control, with different guidelines recommending different targets. For example, although guidelines generally agree on a target hemoglobin (Hb) A1c level of less than 7% for most adults, for frail older patients the American Geriatrics Society recommends a target of less than 8%,5 Veterans Affairs and Department of Defense recommend 8% to 9%,6 and the American Diabetes Association recommends “less stringent glycemic goals” but does not specify what those goals should be.7

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