Special considerations for treatment of XXXX in the elderly.

@entity1 @entity66 @entity6 @entity5217 @entity6170 @entity4053 @entity177 @entity164 @entity16860 @entity4854 @entity413 @entity2449
PURPOSE: The intensity and selection of therapy for the treatment of @entity6 in elderly @entity1 are discussed. SUMMARY: Glycemic control is fundamental in @entity6 care; however, as glycemic goals are approached, the risk of @entity4053 increases. This risk is even greater in the elderly due to many predisposing factors, including @entity177 , polypharmacy, drug-drug interactions, comorbidities, irregular meal patterns, and infrequent self-monitoring of blood @entity413 . When deciding on the desired intensity of @entity6 treatment, the risk of hypoglycemic complications must be weighed against the potential benefit of reducing microvascular and macrovascular complications. Three large-scale, randomized controlled trials examining the effects of intensive versus standard glycemic control on microvascular and macrovascular outcomes in @entity1 with @entity164 2 @entity6 have been published in recent years. In general, a glycosylated hemoglobin (HbA(1c)) goal of <7% is reasonable for most @entity1 . A less-aggressive goal may be considered for @entity1 at high risk of @entity4053 or high risk of complications from @entity4053 , as long as acutely symptomatic @entity4854 is avoided. @entity16860 , @entity5217 , and @entity6170 , which pose a great risk for @entity4053 , should be avoided in the elderly. CONCLUSION: In the absence of clear evidence advocating strict glycemic targets goal of <7% is for elderly @entity1 , an HbA(1c) reasonable for most @entity1 ; however, the risk of hypoglycemic complications must be weighed against the potential benefit of reducing microvascular and @entity66 . @entity2449 may be used as first-line therapy, but @entity16860 and @entity5217 , which pose a great risk for @entity4053 , should be avoided in the elderly. Due to increased cardiovascular risk, use of @entity6170 in the elderly should also be avoided.
