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Ideas and Opinions |21 August 2018

Brief Commentary: Glycemic Targets for Older Adults With Type 2 Diabetes

Emily B. Schroeder, MD, PhD; Andrew J. Karter, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 26 June 2018.
  • Kaiser Permanente Colorado and University of Colorado, Aurora, Colorado (E.B.S.)
    Kaiser Permanente Northern California, Oakland, California (A.J.K.)

    Grant Support: Dr. Schroeder is supported by grants K23 DK099237 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and R01 HS022963 from the Agency for Healthcare Research and Quality. Dr. Karter is supported by grants P30 DK092924 and R01 DK103721 from NIDDK, R56 AG051683 from the National Institute on Aging, R01 LM012355 from the National Library of Medicine, and BAA-13-00119 from the U.S. Food and Drug Administration.

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1471.

    Corresponding Author: Emily B. Schroeder, MD, PhD, Institute for Health Research, Kaiser Permanente Colorado, 2550 South Parker Road, Suite 200, Aurora, CO 80014; e-mail, emily.b.schroeder@kp.org.

    Current Author Addresses: Dr. Schroeder: Institute for Health Research, Kaiser Permanente Colorado, 2550 South Parker Road, Suite 200, Aurora, CO 80014.

    Dr. Karter: Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612.

    Author Contributions: Conception and design: E.B. Schroeder.

    Drafting of the article: E.B. Schroeder.

    Critical revision for important intellectual content: E.B. Schroeder, A.J. Karter.

    Final approval of the article: E.B. Schroeder, A.J. Karter.

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This article has been corrected. The original version (PDF) is appended to this article as a Supplement.
Editors' Note: This commentary was selected for publication from among several submitted in response to a call for readers' perspectives on treatment targets for type 2 diabetes.
Most guidelines recommend individualizing glycemic targets for patients with type 2 diabetes in the context of shared decision making (1–4). In general, this strategy weighs the benefits of treatment against such factors as age, life expectancy, disease complexity, functional and cognitive impairments, risk for adverse drug effects, medication burden, and available resources. Despite the aligned goals of maximizing treatment benefit and safety, organizations have reached different conclusions regarding optimal hemoglobin A1c (HbA1c) targets for older adults with type 2 diabetes.
The American Diabetes Association provides 2 frameworks (1, 2). The first determines how stringent an HbA1c target to pursue on the basis of a list of patient features. The second categorizes older adults into 3 groups (healthy, complex or intermediate, and very complex or poor health), each with a corresponding HbA1c target (<7.5%, <8.0%, and <8.5%). The American Diabetes Association does not recommend HbA1c targets higher than 8.5% because of the “acute risks from glycosuria, dehydration, hyperglycemic hyperosmolar syndrome, and poor wound healing” (2). In contrast, the U.S. Department of Veterans Affairs and Department of Defense outlines a 3 × 3 table of major comorbid conditions, life expectancy, and absence or presence...
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Schroeder EB, Karter AJ. Brief Commentary: Glycemic Targets for Older Adults With Type 2 Diabetes. Ann Intern Med. 2018;169:250–251. [Epub ahead of print 26 June 2018]. doi: https://doi.org/10.7326/M18-1471

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Published: Ann Intern Med. 2018;169(4):250-251.

DOI: 10.7326/M18-1471

Published at www.annals.org on 26 June 2018

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2018 American College of Physicians
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