Risks of Tight Glucose Control in Older Adults: Time to Focus Beyond Mortality

The management of type 2 diabetes in older adults requires balancing glycemic control against treatment-related harms. While guidelines increasingly recommend individualized HbA1c targets, evidence on outcomes beyond mortality and hypoglycemia remains limited. Using linked U.K. primary care, hospital, and mortality data, Shabnam et al. examined whether sustained tight glycemic control (three consecutive HbA1c values <7%) during insulin or sulfonylurea therapy increased fall- or fracture-related hospitalizations in adults aged ≥70 years. In this large observational cohort, tight control was not associated with increased fall or fracture risk, despite higher baseline vulnerability. These findings challenge assumptions equating low HbA1c with overtreatment and support a more nuanced, outcome-based interpretation of glycemic targets in older adults.