Abstract
Type 2 diabetes affects up to 20% of older people living in care homes. This figure could be an underestimate since many cases remain undiagnosed. Owing to the fact that many of these diabetic patients are treated with oral hypoglycemic medications and/or insulin, hypoglycemia remains a concern. Management of this frail population is often complicated by comorbidities, disability, polypharmacy and limited life expectancy. Recently published clinical trials showed no clear cardiovascular benefit of intensive glycemic control and an increased risk of hypoglycemia was observed. Therefore, it seems reasonable that glycemic control in these frail older patients can be relaxed. Given the short life expectancy of these patients, glycemic targets are better focused on the short-term, day-to-day fluctuations in blood glucose levels, since these fluctuations are responsible for symptoms and poor quality of life, rather than a long-term target such as HbA1c. Quality rather than quantity of life should be the primary goal of diabetes care in these settings.
Published Version
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