[Therapeutic strategy for old age-onset diabetes mellitus]

Old-onset diabetes mellitus is often relatively mild in severity. However, if these patients develop marked hyperglycemia, they should be screened for the presence of malignancies, myocardial infarction and cerebral infarction. In addition, we should pay attention to the possible changes in the physical activities, medications and environmental status of the patients. There is no clear evidence how far we should lower blood glucose to prevent complications in those patients. Tight blood glucose control will, however, result in better prognosis in those patients with malignancies, myocardial or cerebral infarction. According to JDS, these patients are recommended to have less than 140 mg/dl of fasting plasma glucose and less than 7% of HbA1c. It is, however, necessary to respect the patient's will, efforts, and pride and is also necessary to adopt a flexible therapeutic strategy tailored to each patient's physical, psychological, and social status.