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Diabetes affects approximately 25% of the population > 65 years, and that percentage is increasing rapidly, particularly in minorities who represent an important fraction of the uninsured/underinsured.Diabetes is an important cause of hospital admissions and a co-morbidity in as high as 50% of hospital inpatients.It impacts mortality and quality of life.While tools have become available to improve glycemic control, enthusiasm for their application must be tempered with the sober realization of the risks involved in intensification of glycemic control, chiefly hypoglycemia.The below recommendations would prevent treatment related emergencies in elderly with type 2 diabetes.HbA1c goals should be stratified for the generally well elderly-HbA1c < 7% and for the frail elderly-HbA1c < 8%.Every effort should be made to choose therapies which are both effective and minimize the risk of hypoglycemia, the chief barrier to improved glycemic control.Such measures include: 1.lifestyle interventions e.g.diet, exercise, meditation, yoga.2.in carefully selected patients the use of metformin, TZDs, GLP-1 analogues, DPP4 inhibitors, α-glucosidase inhibitors, colesevelam, bromocriptine, non-sulfonylurea secretagogues, orlistat, ultra short-acting prandial insulin analogues, and determir or glargine in preference to protaminated basal insulins e.g.NPH.3.Use of insulin pen delivery devices.Current home medication lists with doses and timing with both generic and trade names to reduce dangerous medication errors and reinforce medication compliance.Providers must be attentive to widespread use of alternative therapies by patients which may potentiate the efficacy of prescription anti-diabetic medications.Elderly diabetic patients should be protected from sudden formulary changes by their prescription plans which may precipitously destabilize their glycemic control.Widespread use of Telehealth approaches.