In 1998, the United Kingdom Prospective Diabetes Study led to widespread belief that “intensive control” – typically meaning a hemoglobin A1c level below 7.0% – was the right target. And with “multiple comorbidities” such as heart failure, cancer, and dementia the goal should be 8.0 – 9.0%. For those with “moderate comorbidity” (so-so health) and a life expectancy of less than 10 years the target should be 7.5 – 8.0%. For healthy over 65ers with long life expectancy, the target should be 7.0 – 7.5%. The key measure of diabetes control is hemoglobin A1c. The American Geriatrics Society gives precise guidelines for the goal of diabetes treatment in over 65ers. Tight control is most worthwhile for healthy people who can expect to live at least 10 more years.” Also, the major goal of tight control is to prevent complications many years later. Hypoglycemia can cause strokes and heart attacks in older people. “Elderly people probably should not go on tight control. Several paragraphs later there’s a very clear statement that elderly people with diabetes should be treated differently: In my uninformed state, that’s how I understood how diabetes should be managed, even for over 65ers. Tight control can prevent or slow the progress of many complications of diabetes, giving you extra years of healthy, active life.” “Keeping your blood glucose levels as close to normal as possible can be a lifesaver. The opening two sentences of the American Diabetes Association’s article on “Tight Diabetes Control” make it sound as if “tight control” should be the goal of treatment: As a result, I haven’t kept up on diabetes treatment, so a June 11 article on “Diabetes Overtreatment in Elderly Individuals: Risky Business in Need of Better Management” was news to me. In my subsequent career as a psychiatrist I was not directly responsible for diabetes care, and as an individual, I don’t have the condition. ![]() The last time I was directly responsible for treating diabetes was fifty years ago, when I was an intern in medicine at UCLA.
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