How Important Is Diabetes as a Risk Factor for Cardiovascular and Other Diseases in Older Adults?

PLoS Medicine: How Important Is Diabetes as a Risk Factor for Cardiovascular and Other Diseases in Older Adults?: "Clinical Implications
So what are the implications of the results of this study for clinical practice? Primarily, these data confirm that older adults with diabetes are at very high absolute risk of death from cardiovascular causes (four to five percent per year). Thus, strategies aimed at reducing these risks should be aggressively pursued among such individuals, wherever possible.
Fortunately, a range of preventive treatments of proven efficacy are at our disposal, including blood pressure lowering [9] and the use of statins [10]. Intensive glucose lowering in type 2 diabetes has been shown to reduce microvascular (retinal and renal) events. However, the balance of risks and benefits of lowering haemoglobin A1c levels below seven percent (as recommended by many current guidelines), particularly with respect to macrovascular events such as myocardial infarction and stroke, remains uncertain. At least two large-scale randomised clinical trials evaluating this question are ongoing, one of which has no upper age restriction [11] while the other includes participants aged up to 80 years at randomisation [12]. Importantly, to reach such targets for intensive glucose lowering, insulin therapy will be frequently required. Should the trials demonstrate that the benefits of intensive glucose lowering outweigh the risks, these data, rather than observational data suggesting possible harm associated with the use of insulin, should take precedence in guiding clinical practice."