4.4.0.0 Pa­tients with Com­pli­ca­tions and Re­duced Func­tion­alityFunc­tion­ality

For pa­tients with ad­vanced di­a­betes com­pli­ca­tions, life-‍lim­it­ing co­mor­bid ill­ness­es, or sub­stan­tial cog­ni­tive or func­tion­al im­pair­ments, it is rea­son­able to set less in­ten­sive glycemic goals (Table 12.1). Fac­tors to con­sid­er in in­di­vid­u­alizing glycemic goals are out­lined in Fig. 6.1. These pa­tients are less like­ly to benefit from re­duc­ing the risk of microvas­cu­lar com­pli­ca­tions and more like­ly to suf­fer se­ri­ous ad­verse ef­fects from hy­po­glycemia. How­ev­er, pa­tients with poor­ly con­trolled di­a­betes may be sub­ject to acute com­pli­ca­tions of di­a­betes, in­clud­ing de­hy­dra­tion, poor wound heal­ing, and hy­per­glycemic hy­per­os­mo­lar coma. Glycemic goals at a min­i­mum should avoid these con­se­quences.