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Intensive Glucose Control in Older Patients With Diabetes

Andy Lazris, MD
Alan Roth, DO
Helen Haskell
John James

American Family Physician. 2025;112(6):668-670.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

ANDY LAZRIS, MD, CMD, Personal Physician Care, Columbia, Maryland

ALAN ROTH, DO, FAAFP, FAAHPM, Jamaica Hospital Medical Center Ringgold, New York, New York

Address correspondence to Andy Lazris, MD, CMD, at alazris50@gmail.com.

Author disclosure: No relevant financial relationships.

  1. 1.Woolf SH, Rothemich SF. New diabetes guidelines: a closer look at the evidence. Am Fam Physician. 1998;58(6):1287-1288.
  2. 2.Lazris A, Roth AR, Haskell H, et al. Prediabetes diagnosis: helpful or harmful? Am Fam Physician. 2021;104(6):649-651.
  3. 3.American Diabetes Association. 12. Older adults: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43(suppl 1):S152-S162.
  4. 4.Hemmingsen B, Lund SS, Gluud C, et al. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013(11):CD008143.
  5. 5.Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-2559.
  6. 6.Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129-139.
  7. 7.Patel A, MacMahon S, Chalmers J, et al.; The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560-2572.
  8. 8.Hemmingsen B, Lund SS, Gluud C, et al. Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. BMJ. 2011;343:d6898.
  9. 9.Kelly TN, Bazzano LA, Fonseca VA, et al. Systematic review: glucose control and cardiovascular disease in type 2 diabetes. Ann Intern Med. 2009;151:394-403.
  10. 10.Lipscombe LL, Gomes T, Lévesque LE, et al. Thiazolidinediones and cardiovascular outcomes in older patients with diabetes. JAMA. 2007;298(22):2634-2643.
  11. 11.Simpson SH, Majumdar SR, Tsuyuki RT, et al. Dose-response relationship between sulfonylurea drugs and mortality in type 2 diabetes: a population-based cohort study. CMAJ. 2006;174(2):169-174.
  12. 12.Mitka M. Aggressive glycemic control might not be the best choice for all diabetes patients. JAMA. 2010;303(12):1137-1138.
  13. 13.Lega LC, Campitelli MA, Austin PC, et al. Potential diabetes over-treatment and risk of adverse events among older adults in Ontario: a population-based study. Diabetologia. 2021;64(5):1093-1102.
  14. 14.Bruderer SG, Bodmer M, Jick SS, et al. Incidence of and risk factors for severe hypoglycaemia in treated type 2 diabetes mellitus patients in the UK—a nested case-control analysis. Diabetes Obes Metab. 2014;16(9):801-811.
  15. 15.Hope SV, Taylor PJ, Shields BM, et al. Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia. Prim Care Diabetes. 2018;12(2):139-146.
  16. 16.Lee AK, Juraschek SP, Windham BG, et al. Severe hypoglycemia and risk of falls in type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) study. Diabetes Care. 2020;43(9):2060-2065.
  17. 17.Whitmer RA, Karter AJ, Yaffe K, et al. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301(15):1565-1572.
  18. 18.Yau CK, Eng C, Cenzer IS, et al. Glycosylated hemoglobin and functional decline in community-dwelling nursing home-eligible elderly adults with diabetes mellitus. J Am Geriatr Soc. 2012;60(7):1215-1221.
  19. 19.Martens T, Beck RW, Bailey R, et al. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin: a randomized clinical trial. JAMA. 2021;325(22):2262-2272.
  20. 20.Lin K. Are continuous glucose monitors overrated and overused? American Family Physician Community Blog, June 28, 2021. Accessed August 1, 2025. https://www.aafp.org/pubs/afp/afp-community-blog/entry/are-continuous-glucose-monitors-overrated-andoverused.html
  21. 21.Seidu S, Kunutsor SK, Ajjan RA, et al. Efficacy and safety of continuous glucose monitoring and intermittently scanned continuous glucose monitoring in patients with type 2 diabetes: a systematic review and meta-analysis of interventional evidence. Diabetes Care. 2024;47(1):169-179.
  22. 22.The patient advocacy groups that accept the most big pharma money. ClassAction.com. July 2, 2018. Accessed August 1, 2025. https://www.classaction.com/news/patient-advocacy-groups-big-pharma/
  23. 23.Lupkin S, Lucas E, Knight V. Big pharma gave money to patient advocacy groups opposing Medicare changes. KFF Health News. March 4, 2019. Accessed August 1, 2025. https://kffhealthnews.org/news/big-pharma-gave-money-to-patient-advocacy-groups-opposing-medicare-changes/

Lown Institute Right Care Alliance is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and to put patients, not profits, at the heart of health care.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Lown Right Care published in AFP is available at https://www.aafp.org/afp/rightcare.

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