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Treatment of Diabetes in Older Patients

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Assessment 6 Table 3. Conceptual Framework for Considering Overall Health and Patient Values in Determining Clinical Targets in Adults Aged 65 and Older Overall Health Category Group 1 Group 2 Group 3 Good health Intermediate health Poor health Patient characteristics No comorbidities or 1–2 non- diabetes chronic illnesses a and No ADL e impairments and ≤1 IADL impairment 3 or more non- diabetes chronic illnesses a and/or Any one of the following : • mild cognitive impairment or early dementia • ≥2 IADL impairments Any one of the following : • End-stage medical condition(s) b • Moderate to severe dementia • ≥2 ADL impairments • Residence in a long- term nursing facility Use of drugs that may cause hypoglycemia (e.g., insulin, sulfonylurea, glinides) No Fasting : 90–130 mg/dL Bedtime: 90–150 mg/dL <7.5% Fasting : 90–150 mg/dL Bedtime: 100–180 mg/dL <8% Fasting : 100–180 mg/dL Bedtime: 110–200 mg/dL <8.5% d Yes c Fasting : 90–150 mg/dL Bedtime: 100–180 mg/dL ≥7.0 and <7.5% Fasting : 100–150 mg/dL Bedtime: 150–180 mg/dL ≥7.5 and <8.0% Fasting : 100–180 mg/dL Bedtime: 150–250 mg/dL ≥8.0 and <8.5% d Shared decision-making: individual goal may be lower or higher Reasonable glucose target ranges and HbA1c by group

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