"What I suggest we do first is, we shouldn't have a diabetes target of A1c of 'less than,' says Lee. "It should be a range, 6.5 to 7 or between 6.5 to 7.5." But this has not yet been incorporated in national guidelines set by the National Committee for Quality Assurance, nor is it yet a measure endorsed by the National Quality Forum.
Of special concern is the question the report raises about whether insulin should be prescribed at all for patients over age 80, especially those who take other medications that could cross react, and especially if their cognitive abilities make them unable to take the right dose in the right way all the time. While Geller says his research doesn't have the data to say yes or no to that question, Lee has a different view.
"Insulin should be avoided in most non-hospitalized adults older than 80 years," he wrote. "Most in this age group have significant comorbid conditions, functional limitations, and limited life expectancy." All it does for people at that age, he says, is expose them to "the immediate hypoglycemia risks with little chance of benefit. Although some persons in their 80s are unusually healthy and may benefit from insulin, most are likely to be harmed."