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"Tight control" in geriatrics: the emperor wears a thong.

Abstract

The deep-seated faith in tight glycemic control for patients with type 2 diabetes mellitus shows signs of moderating, especially for elderly adults, but faith in the importance of a glycosylated hemoglobin goal of 7% retains a strong influence over many clinicians. This faith persists despite weak evidence from randomized controlled trials of any meaningful benefit from "tight control" in any patient group, consistent evidence of lack of benefit for many outcomes, and an almost complete lack of evidence about elderly adults or those with extensive vascular disease. Clinicians who care for these vulnerable individuals face a strong public belief in "tight control" and an orchestrated campaign to increase medication use. Although no benefit has been shown in elderly adults, some harms are clear, and others are likely.

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  • Publisher Full Text
  • Authors+Show Affiliations

    School of Medicine, Johns Hopkins University, Baltimore, Maryland 21224, USA. tfinucan@jhmi.edu

    Source

    MeSH

    Aged
    Blood Glucose
    Diabetes Mellitus, Type 2
    Humans
    Hypoglycemic Agents
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22881447

    Citation

    Finucane, Thomas E.. ""Tight Control" in Geriatrics: the Emperor Wears a Thong." Journal of the American Geriatrics Society, vol. 60, no. 8, 2012, pp. 1571-5.
    Finucane TE. "Tight control" in geriatrics: the emperor wears a thong. J Am Geriatr Soc. 2012;60(8):1571-5.
    Finucane, T. E. (2012). "Tight control" in geriatrics: the emperor wears a thong. Journal of the American Geriatrics Society, 60(8), pp. 1571-5. doi:10.1111/j.1532-5415.2012.04057.x.
    Finucane TE. "Tight Control" in Geriatrics: the Emperor Wears a Thong. J Am Geriatr Soc. 2012;60(8):1571-5. PubMed PMID: 22881447.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - "Tight control" in geriatrics: the emperor wears a thong. A1 - Finucane,Thomas E, Y1 - 2012/08/06/ PY - 2012/8/14/entrez PY - 2012/8/14/pubmed PY - 2012/10/25/medline SP - 1571 EP - 5 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 60 IS - 8 N2 - The deep-seated faith in tight glycemic control for patients with type 2 diabetes mellitus shows signs of moderating, especially for elderly adults, but faith in the importance of a glycosylated hemoglobin goal of 7% retains a strong influence over many clinicians. This faith persists despite weak evidence from randomized controlled trials of any meaningful benefit from "tight control" in any patient group, consistent evidence of lack of benefit for many outcomes, and an almost complete lack of evidence about elderly adults or those with extensive vascular disease. Clinicians who care for these vulnerable individuals face a strong public belief in "tight control" and an orchestrated campaign to increase medication use. Although no benefit has been shown in elderly adults, some harms are clear, and others are likely. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/22881447/full_citation L2 - https://doi.org/10.1111/j.1532-5415.2012.04057.x DB - PRIME DP - Unbound Medicine ER -