In elderly type 2 diabetics with comorbid illness or functional
impairment, the benefit of intensive glucose control to a maximum
hemoglobin A1c of 7% (versus moderate control to HbA1c 7.9%) appears
to be only modest, according to research reported in the July 1st
issue of the Annals of Internal Medicine.

"Whether or not older, sicker diabetes patients should adopt the
intensive medication regimen necessary to achieve intensive glucose
control is an area of ongoing clinical and policy controversy,"
first author Dr. Elbert S. Huang of the University of Chicago told
Reuters Health.

"Because older, sicker patients are typically excluded from
controlled trials, we used a computer simulation model to evaluate
the expected benefits of intensive glucose control in these
patients," Dr. Huang said.

The model predicts that type 2 diabetic patients, ages 60 to 80
years, who start with a moderate or high level of comorbid illness
or functional impairment will have "minimal benefits of pursuing
intensive glucose control," Dr. Huang noted.

Among older adults of different age groups with various life
expectancies, the benefit of intensive glucose control ranged from
51 to 116 additional quality-adjusted days. "Within each age
(group), the expected benefits of intensive glucose control steadily
declined as the level of comorbid illness and functional impairment
increased," Dr. Huang and colleagues report.

"Age itself was not the primary determinant of lower expected
benefits of intensive glucose control," Dr. Huang said.

"The results suggest," the researcher concludes, "that it is
clinically reasonable to relax glucose targets for older patients
with significant comorbid illness and permanent functional
impairment. Age alone cannot be used to make this determination."

The findings in this study, the researchers write, "provide a
starting point for discussions between older diabetic patients and
their providers about the value of pursuing a complex therapy, such
as intensive glucose control."

Ann Intern Med 2008;149:11-19.