Is tight control contraindicated in any group of patients?
Tight control should not be attempted by patients unable or unwilling to participate actively in their glucose management. Tight control is contraindicated in infants <2 years of age. It should be undertaken with extreme caution in children between the ages of 2 and 7 years because hypoglycemia may impair normal brain development, which is not complete until 7 years of age. The danger of hypoglycemia is greater in infants and children because food intake, activity, and adherence to treatment schedules are less predictable than in adults. Because preadolescents appear to be relatively protected from microvascular complications, the need for tight control might be less than in postpubertal subjects. Older patients with significant atherosclerosis may be vulnerable to permanent injury from hypoglycemia. Although there are few absolute contraindications to tight control, relative contraindications will be more frequent. Clinical judgment and common sense will be required in decision making
