Hypoglycemia is one of the severe complications of diabetes. To prevent hypoglycemia, an emphasis is placed on maintaining an appropriate balance between nutrition, activity, and treatment, which can be achieved by the repetition of self-trials based on self-monitoring. Clinicians routinely focus on patients’ contribution, including timely intake of an adequate amount of carbohydrates, physical activity, antidiabetic medication, and abstinence from alcohol. Recently, many guidelines have highlighted the importance of clinicians’ factors and recommend individualized treatments according to lifestyle patterns and specific needs following the de-intensification of treatment. The optimal value of hemoglobin A1c (HbA1c) levels for blood glucose level regulation remains controversial among countries, but it generally does not exceed 8.0%. In populations that are at a risk of hypoglycemia, such as the older adults, it is advisable to adjust the target blood glucose level to less than 8.0%. Meanwhile, a blood glucose level of 7.0%–7.5% is generally recommended for healthy older adults. If the expected lifetime is shorter than 10 years or in patients with chronic kidney disease and severe cardiovascular disease, the HbA1c level target can be increased to 7.5%–8.0%. For even shorter lifetime expectancy, the target can be adjusted up to 8.0%–9.0%. To prevent hypoglycemia, the target blood glucose level needs to be adjusted, particularly in older adult patients. Ultimately, it is important to identify the maximum blood glucose levels that do not cause hypoglycemia and the minimum blood glucose levels that do not cause hyperglycemia-associated complications.

Citations

• Initiating an Insulin Safety Campaign to reduce the incidence of glycemic harm events for hospitalized adults 65 and older
  Michelle Cohen, Kristen de Grandpre, William M. Herlihy, Lise Cooper
  Journal of the American Geriatrics Society.2025; 73(2): 602.     CrossRef
• Hyperglycaemia aversion in type 1 diabetes: A grounded theory study
  Vicky McKechnie, Nick Oliver, Stephanie A. Amiel, John R. E. Fox
  British Journal of Health Psychology.2024; 29(1): 254.     CrossRef
• Review—Glucose Monitoring Sensors: History, Principle, and Challenges
  Yanzhen Jing, Shwu Jen Chang, Ching-Jung Chen, Jen-Tsai Liu
  Journal of The Electrochemical Society.2022; 169(5): 057514.     CrossRef

Background: We assessed the state of diabetes control in Korean adults from the 2001 Korean National Health and Nutrition Survey. Methods: A total of 271 adult diabetes patients (125 males, 146 females) were identified from the health interview survey. Diabetes control status was assessed by the American Diabetic Association (ADA) recommendations. Socioeconomic characteristics and the health status were assessed by an interview and the health- related behavior was assessed by self-questionnaire. A one-day 24-hour recall was used for the dietary assessment. Blood pressure and anthropometric measurements were done. Fasting blood was drawn for glucose, HbA1c, and lipids profile. Results: The proportions of patients reaching the recommended goals for fasting plasma glucose (≤130 mg/dl), HbA1c (＜7%), blood pressure (＜130/80 mmHg), low density lipoprotein cholesterol (＜100 mg/dl), triglyceride (＜200 mg/dl), and high density lipoprotein cholesterol (＞45 mg/dl for males, ＞55 mg/dl for females) were 57.2%, 19.9%, 24.4%, 27.8%, 64.5% and 20.7%, respectively. Body mass index, and smoking in males and age, and diabetes duration in females were associated with HbA1c level. Conclusion: This study shows that diabetes in Korean adult is not adequately controlled. National effort is needed to achieve the recommended treatment goals and to manage modifiable risk factors such as obesity and smoking. (J Korean Acad Fam Med 2008;29:658-667)