Unfortunately, aging is a risk factor for severe hypoglycemia with efforts to intensify therapy (30).
Asymptomatic hypoglycemia, as assessed by continuous glucose monitoring, is frequent in this population (31).
This increased risk of hypoglycemia appears to be due to an age-related reduction in glucagon secretion, impaired awareness of hypoglycemic warning symptoms and altered psychomotor performance, which prevents the patient from taking steps to treat hypoglycemia (32,33).
Episodes of severe hypoglycemia may increase the risk of dementia (34), although this is controversial.
Cognitive dysfunction in elderly subjects has been identified as a significant risk factor for the development of severe hypoglycemia (35,36).
Therefore, the most important issue to address when attempting to achieve treatment guidelines in elderly patients is to prevent hypoglycemia as much as possible, even if that means that higher glycemic targets must be used.