The American Geriatrics Society and other medical organizations have revised diabetes guidelines for older adults, suggesting that a lower target hemoglobin A1c (HbA1c) level may be more beneficial. Ora Larson, an 85-year-old woman with Type 2 diabetes, was treated aggressively for years but experienced frequent hypoglycemic episodes, prompting her to reevaluate her treatment plan.
According to Dr. Scott Pilla, a diabetes researcher at Johns Hopkins, older adults are at increased risk of severe hypoglycemia due to age-related changes in body function and medication side effects. Insulin and sulfonylureas, commonly used for Type 1 and Type 2 diabetes, respectively, can cause severe hypoglycemic episodes.
The revised guidelines take into account the long-term benefits of tight glycemic control versus the increased risk of hypoglycemia as patients age. “Tight control is less important now,” said Dr. Lee. “Older people already have a variety of health problems, and it’s not worth risking severe hypoglycemia.”
Experts recommend that older adults with diabetes work closely with their doctors to weigh the benefits of blood-sugar lowering against the risk of medications. With the increasing availability of new diabetes treatments, including continuous glucose monitors, figuring out the optimal treatment plan can be challenging.
Ora Larson is taking steps to reevaluate her diabetes treatment by discussing it with her doctor and considering alternative options. “The biggest risk factor for severe hypoglycemia is having had hypoglycemia before,” Dr. Lee said. If you have experienced hypoglycemia, it’s essential to work closely with your doctor to determine the best course of action.
Source: https://www.sandiegouniontribune.com/2025/04/15/older-people-may-not-need-to-watch-blood-sugar-so-closely