Avoid using medications that may cause low blood sugar to achieve HbA1c below 53 mmol/mol in frail older adults, as moderate control is usually preferable 

Rationale 

There is no evidence supporting HbA1c reduction below 53 mmol/mol in older adults with type 2 diabetes. Intensive treatment has been shown to increase episodes of hypoglycemia in this population. Since it takes approximately eight years to achieve the benefits of intensive treatment, treatment goals should be adjusted based on the patient’s individual treatment objectives, health status, and life expectancy. For healthy older adults with a long life expectancy, an HbA1c target of 53–59 mmol/mol may be appropriate. For those with moderate comorbidity and a life expectancy of less than 10 years, a target of 58–64 mmol/mol may be suitable. For individuals with multiple comorbidities and shorter life expectancy, an HbA1c target of 64–69 mmol/mol is recommended.  
  
References

• Bourdel Marchasson, I, Maggi, S, Tessier, D, et al (2022). Essential Steps in Primary Care Management of Older People with Type 2 Diabetes - A Position Statement on behalf of the European Geriatric Medicine Society (EuGMS) and the European Diabetes Working Party for Older People (EDWPOP) Collaboration.  
• Finucane, T. E. (2012). ""Tight control" in geriatrics: the emperor wears a thong." J Am Geriatr Soc 60(8): 1571-1575. 
• Group, A. C. et al (2008). "Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes." N Engl J Med 358(24): 2560-2572. 
• Group, A. S. et al (2011). "Long-term effects of intensive glucose lowering on cardiovascular outcomes." N Engl J Med 364(9): 818-828. 
• Kirkman, M. S. et al (2012). "Diabetes in older adults." Diabetes Care 35(12): 2650-2664. 
• Montori, V. M. and M. Fernández-Balsells (2009). "Glycemic control in type 2 diabetes: time for an evidence-based about-face?" Ann Intern Med 150(11): 803-808.