امرأة عمرها ٧٤ سنة في دار رعاية، مصابة بالسكري، سكرها التراكمي ٦٫١٪ على جليكلازايد وإنسولين، ونقص وزنها، وسقطت مرتين، وعندها خرف خفيف. ما التعديل الأنسب؟

A 74-year-old diabetic care-home resident has HbA1c 6.1% on gliclazide and insulin, has lost weight, has fallen twice and has mild dementia. Which adjustment is most appropriate?

1. Add a third drug to tighten control further
2. De-intensify and relax the target to avoid lows
3. Keep the plan unchanged because control is excellent
4. Increase insulin to reach an HbA1c of 5.5%

Answer: B) De-intensify and relax the target to avoid lows. In frail older adults hypoglycaemia is more dangerous than mild hyperglycaemia; targets are relaxed (e.g. below 8–8.5%) and hypoglycaemia-causing drugs reduced.