7
Table 3. Conceptual Framework for Considering Overall
Health and Patient Values in Determining Clinical
Targets in Adults Aged 65 and Older
Notes: While glucose targets are highlighted for each group in this framework, overall
health categories can also be considered for other treatment goals such as blood pressure
and dyslipidemia.
a
Coexisting chronic illnesses may include osteoarthritis, hypertension, chronic kidney
disease stages 1–3, or stroke, among others.
b
One or more chronic illnesses with limited treatments and reduced life expectancy.
ese include metastatic cancer, oxygen-dependent lung disease, end-stage kidney
disease requiring dialysis, and advanced heart failure.
c
As long as achievable without clinically significant hypoglycemia; otherwise, higher
glucose targets may be appropriate. Note also that the lower HbA1c boundary was
included as data suggesting increased hypoglycemia and mortality risk at lower HbA1c
levels are strongest in the setting of insulin use. However, the lower boundary should
not reduce vigilance for detailed hypoglycemia assessment.
d
HbA1c of 8.5% correlates with an average glucose level of approximately 200 mg/dL.
Higher targets than this may result in glycosuria, dehydration, hyperglycemic crisis and
poor wound healing.
e
ADLs include bathing, dressing, eating, toileting, and transferring, and IADLs
include preparing meals, shopping, managing money, using the telephone, and
managing medications.
Source: Adapted from: Cigolle CT, Kabeto MU, Lee PG, Blaum CS. Clinical
complexity and mortality in middle-aged and older adults with diabetes. J Gerontol A
Biol Sci Med Sci 2012; 67 (12):1313-20 and Kirkman MS, Jones Briscoe V, Clark N, et
al. Diabetes in older adults. Diabetes Care 2012; 35(12): 2650-2664.
(cont'd)
