Older adults with type 2 diabetes mellitus (T2DM) and multiple comorbidities face a high risk of hypoglycemia when intensively treated with insulin or sulfonylureas. In line with the Choosing Wisely initiative and ADA 2025 recommendations emphasizing individualized HbA1c targets, this study aimed to evaluate the prevalence of potential glycemic overtreatment and the impact of a hospital-wide educational program on clinical outcomes in high-risk older adults.

Outpatients aged ≥70 years with T2DM and a history of cancer, dementia, or stroke who were prescribed insulin or sulfonylureas were included. Baseline data (January–June 2025) were compared with post-intervention results (September 2025) following internal education promoting less stringent HbA1c targets goals (≥7%) to prevent hypoglycemia. Indicators included the proportion of patients with HbA1c <7%, documented hypoglycemia (glucose <70 mg/dL), and emergency department (ED) visits for hypoglycemia.

Before the intervention (n=111), 43.2% had HbA1c <7%, 38.7% experienced hypoglycemia, and 23.4% required ED visits. After education, in a follow-up cohort (n=8), HbA1c <7% was 50%, and both hypoglycemia and ED visits were 37.5%. At the hospital-wide level, the number of patients aged ≥70 years presenting with hypoglycemia (<70 mg/dL) declined steadily from 127 cases during January–June 2025, to 27 cases in July, 26 in August, and 19 in September 2025, suggesting a sustained improvement after educational promotion.

A Choosing Wisely-based educational intervention improved awareness of appropriate glycemic targets and reduced potential overtreatment among older adults with T2DM. Continuous monitoring and multidisciplinary education can further enhance patient safety and optimize diabetes management.