title: Management of the patient with advanced complications, functional decline, and persistent hyperglycemia.
abstract: OBJECTIVE
  Current management of hypoglycemic risk among seniors with type 2 diabetes mellitus (T2DM) is frequently not very effective. Treatment guidelines with target glycosylated hemoglobin (A1C) levels provide important standards for T2DM management, but target goals must be determined on an individual basis in conjunction with individual factors, including risk of hypoglycemia. This clinical review will help pharmacists develop optimal therapeutic regimens for elderly diabetic patients that carefully balance risks and benefits of therapy, better assess their elderly patients' risk of hypoglycemia, and determine appropriate blood glucose testing schedules for the long-term care patient.
  
  
  METHODS
  Live symposium presentation based on clinical practice and research, medical literature, and studies published between January 1998 and April 2009 on managing diabetes in older adults, government statistics, and medical society guidelines.
  
  
  CONCLUSIONS
  When treating seniors with T2DM, it is critical that hypoglycemia be identified and avoided. Hypoglycemia, whether undiagnosed, recurring, or brought about with the use of traditional insulin or other antihyperglycemic agents with higher hypoglycemic risk, can lead to the risk of falls and injuries related to that. Certain therapeutic measures, including alterations to blood glucose testing schedules, less stringent A1C goals, and insulin analog therapies, facilitate effective glycemic control and decrease the risk of hypoglycemia.
authors: The Diabetes Center, in Old Saybrook, Connecticut 06475, USA. diabctr@sbcglobal.net
authors: Donald K
authors: DK
authors: Zettervall
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007003:Hypoglycemia / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D010595:Pharmacists / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents