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● The ultimate goals are to avoid acute osmotic symptoms of hyperglycemia and to prevent/delay the development of diabetes complications.
● Glycemia and HbA1c are useful control parameters, with target values determined by the patient's profile.
● In older adults (>65-70) you focus on therapy safety, as the risk for hypoglycemia and the resulting injuries is high and the lifetime remaining to develop cardiovascular complications short. But encourage safe lifestyle changes, as even modest weight loss (5-10%) and any physical activity improve glycemia. Both weight reduction and HbA1c target values goals should be numerically defined and clearly communicated. HbA1c values of 7.5-8.0% or even higher are acceptable in the elderly as well as in patients with severe hypoglycemic episodes, with multiple, especially cardiovascular, comorbidities ("point of no return" concept), and in those in who miss the set HbA1c values despite repeated training and polytherapy, including insulin.
● Conversely, most stringent HbA1c target values (<6.5-7.0%) should be set for newly or recently diagnosed, motivated patients with long life expectancy and no cardiovascular complications or comorbidities.
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