For patients over the age of 60 it appears that the target hemoglobin A1c level of less than 6.0% are associated with a higher death rate. This happens despite the fact that the complications of type 2 diabetes are far lower when A1c levels are less than 6.0%. The best overall outcomes occur with A1c levels between 6.0 and 8.0.
Nonetheless, the best treatment for type 2 diabetes is lifestyle management. Ironically, one of the very things drugs are designed to do is lower the risk of heart attack; yet most drugs substantially increase the risk for heart attack! Avandia is the classic example. It is disappointing that our FDA has not followed European drug administrations by banning its use.