Type 2 Diabetes Mellitus: Rational Management

00:00 What does one do with hemoglobin A1c levels between 7% and 8%? Evidence shows that treating targets of less than 7% compared with targets around 8% do not reduce death or macrovascular events over about 5-10 years of treatment but do result in harm. Low blood sugar targets may be appropriate for patients who have a long life expectancy usually in the range of greater than 15 years and in patients who are interested in more intensive glycemic control with pharmacological therapy despite the risk of hypoglycemia. When discussing rational diabetes management, avoid targeting lower hemoglobin A1c levels in patients with a low life expectancy. Advanced age 80 years or older, residents in nursing homes or those with chronic active medical conditions do not do well when blood sugars are very very tightly controlled as the incidence of hypoglycemia increases. Harm clearly outweighs the benefits in these populations. Focus on treating these patients to reduce symptoms from disease or treatment rather than setting stringent treatment targets.