Choosing Wisely:

Don’t medicate to achieve tight glycemic control in older adults. Moderate control is generally better.

Rationale and Comments: There is no evidence that using medications to achieve tight glycemic control in older adults with type 2 diabetes is beneficial. Among nonolder adults, except for reductions in myocardial infarction and mortality with metformin, using medications to achieve glycated hemoglobin levels less than 7% is associated with harms, including higher mortality rates. Given the long time frame to achieve theorized microvascular benefits of tight control, glycemic goals should reflect patient goals, health status, and life expectancy.
Sponsoring Organizations:
  • American Geriatrics Society
  • Sources:
  • Randomized controlled trials
  • Disciplines:
  • Geriatric Medicine
  • Endocrinologic
  • References: • ACCORD Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;258(24):2545-59.
    • ACCORD Study Group. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med. 2011;364(9):818-28.
    • Duckworth W, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129-39.
    • ADVANCE Collaborative Group, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-72.
    • UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. Lancet. 1998;352: 854-65.
    • Montori VM, et al. Glycemic control in type 2 diabetes: time for an evidence-based about-face? Ann Intern Med. 2009; 150(11):803-8. [Erratum: Ann Intern Med. 2009;151(2): 144].
    • Finucane T. “Tight control” in geriatrics: the emperor wears a thong. J Am Geriatr Soc. 2012;60:1571-5.

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