Committee Report: Glycemic targets for elderly patients with diabetes

doi: 10.1111/jdi.12599 With the accelerated aging of society, the number of elderly patients with diabetes continues to rise in Japan. The elderly have specific health problems that vary widely among individuals. In particular, susceptibility to severe hypoglycemia is a hallmark of elderly diabetes. Severe hypoglycemia not only impairs cognitive function but can also increase the risk of cardiovascular events. Against this background, the Japan Diabetes Society (JDS)/Japan Geriatrics Society (JGS) Joint Committee on Improving Care for Elderly Patients with Diabetes was launched in April 2015. As a first step toward developing ‘Clinical Practice Guidelines for the Management of Elderly Patients with Diabetes’, the Joint Committee launched an in-depth debate on glycemic targets for elderly diabetes. Over a series of discussions, the Joint Committee drew on the available reports on glycemic targets for the elderly, which included the Japanese Elderly Diabetes Intervention Trial (JEDIT) study, the American Diabetes Association (ADA)/ American Geriatrics Society (AGS) Consensus report, International Diabetes Federation (IDF)’s Global Guideline, and other relevant reports in the pertinent literature, and developed the ‘Glycemic Targets for Elderly Patients with Diabetes’ described in Figure 1 shown below. The Joint Committee’s consensus is summarized as follows: 1. The glycemic target is to be determined for each elderly patient by taking into account the patient’s background characteristics and health status (e.g., age, cognitive function, physical function [basic and instrumental activities of daily living {ADL}]), comorbidities, risk for severe hypoglycemia, and life expectancy; 2. The lower limit of the glycemic target is to be targeted to ensure safer glycemic control in those likely to be at risk of severe hypoglycemia; and 3. The Joint Committee’s recommendations allow the glycemic targets to be adjusted to exceed or fall below the glycemic targets suggested in the Table to ensure patient-centered care while providing the glycemic targets and their lower limits as a basis for glycemic control in elderly patients with diabetes.