title: Improving Care in Older Patients with Diabetes: A Focus on Glycemic Control.
abstract: Diabetes affects more than 25% of Americans older than age 65 years. The medical care of older patients must differ from the care of their younger counterparts. Older patients are at high risk of drug toxicity. A hemoglobin A1c (HbA1c) level less than 7.0% has historically been the goal of all patients with diabetes, regardless of age. Recent research has demonstrated that using medications to achieve such tight glycemic control is not necessary and is often not safe.This article discusses the seminal research findings that strongly suggest that HbA1c goals should be relaxed in older patients. The authors then recommend an age-specific and functionally appropriate HbA1c reference range for patients receiving medications to improve glycemic control. Other interventions are suggested that should make diabetes care safer in older patients receiving hypoglycemic medications.
authors.affiliation: Assistant Chief of Internal Medicine at the West Los Angeles Medical Center and Co-Chair of the Southern California Permanente Medical Group High Risk Drugs in the Elderly Committee in Pasadena. eric.a.lee@kp.org.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Lee
authors.affiliation: Former Regional Coordinating Chair for Geriatrics and Continuing Care for Kaiser Permanente Southern California and Co-Chair of the Southern California Permanente Medical Group High Risk Drugs in the Elderly Committee in Pasadena. nancy.e.gibbs@kp.org.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Gibbs
authors.affiliation: Internist at the Los Angeles Medical Center and Co-Director of the Southern California Permanente Medical Group Diabetes Complete Care Program in Pasadena. john.p.martin@kp.org.
authors.forename: John
authors.initials: J
authors.lastname: Martin
authors.affiliation: Physician-in-Charge of Endocrinology at the Woodland Hills Medical Center in CA and the Regional Coordinating Chair for Endocrinology for Kaiser Permanente Southern California. fred.h.ziel@kp.org.
authors.forename: Fred
authors.initials: F
authors.lastname: Ziel
authors.affiliation: Former Clinical Operations Senior Pharmacy Consultant for Medication Management and Safety for the Southern California Permanente Medical Group in Pasadena.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Polzin
authors.affiliation: Medical Director of the Regional Reference Laboratories and the Regional Assistant Medical Director of Laboratory Services for the Southern California Permanente Medical Group in Pasadena. darryl.e.palmer-toy@kp.org.
authors.forename: Darryl
authors.initials: D
authors.lastname: Palmer-Toy
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards*; D012016:Reference Values
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents