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Ye-Fong Du,1 Horng-Yih Ou,1 Elizabeth A Beverly,2 Ching-Ju Chiu3 1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 2Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA; 3Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan Abstract: The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the elderly. Because of the unique characteristics of elderly people with T2DM, therapeutic strategy and focus should be tailored to suit this population. This article reviews the guidelines and studies related to older people with T2DM worldwide. A few important themes are generalized: 1) the functional and cognitive status is critical for older people with T2DM considering their life expectancy compared to younger counterparts; 2) both severe hypoglycemia and persistent hyperglycemia are deleterious to older adults with T2DM, and both conditions should be avoided when determining therapeutic goals; 3) recently developed guidelines emphasize the avoidance of hypoglycemic episodes in older people, even in the absence of symptoms. In addition, we raise the concern of glycemic variability, and discuss the rationale for the selection of current options in managing this patient population. Keywords: glycemic target, glycemic variability, blood glucose, frailty