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BACKGROUND Diabetes mellitus is common in the elderly, and therapy offers many benefits but also has many risks. Experts suggest a hbA1c of < 8% indicates better care for people > 80 years old, but evidence-based guidelines specific to the elderly are scarce. OBJECTIVES To correlate serious episodes of hypoglycemia (blood sugar < 65 with symptoms) with patient-specific factors and medication use. METHODS Prospectively designed retrospective explicit electronic chart review of 140 patients randomly selected out of a pool of 525 consecutive patients with diabetes that visited our clinic 8/1-10/30/2010. We excluded subjects as follows: age < 65 (n=3), mislabeled as diabetics (n=6), no follow up visit 4/1-10/30/2011 (n=6), or no follow up HbA1c after enrollment (n=8). Serious hypoglycemia was defined as blood sugar less than 65 with reported symptoms. Chi2 and logistic regression techniques were used to investigate the efficacy (levels of HbA1c, LDL) and safety (serious hypoglycemia) of chosen medication classes and achieved therapeutic goals. RESULTS The mean age was 78+/-8 years (range 65-100). Other baseline characteristics and univariate results are shown in table 1. 96% were on statins, yet only 32% had an LDL <100. Serious hypoglycemia was found in 23 patients (20%), and on multivariable analysis was associated with use of sulfonylurea and insulin but not with age, chronic kidney disease, cognitive impairment or HbA1c level. CONCLUSION Serious hypoglycemia in the elderly was associated with medication class but not co-morbidities or level of diabetes control. (Figure presented)