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objectives assess whether patient perceptions treatments diabetes mellitus differ according clinical criteria limited life expectancy functional decline ie vulnerability design crosssectional survey setting clinics affiliated two chicagoarea hospitals participants patients aged 65 older living type 2 diabetes mellitus n332 measurements utilities quantitative measures preference scale 0 1 0 representing state equivalent death 1 representing life perfect health assessed nine hypothetical treatment states using time tradeoff questions patients queried specific concerns regarding medications vulnerability defined according vulnerable elders scale results thirtysix percent patients vulnerable vulnerable patients older 77 vs 73 diabetes mellitus longer 13 vs 10 years p lt05 vulnerable patients reported lower utilities nonvulnerable patients individual treatment states eg intensive glucose control mean 061 vs 072 p lt01 within group variation large groups eg standard deviations gt025 although mean individual state utilities differed across groups significant differences found vulnerable nonvulnerable patients compared intensive conventional treatment states eg intensive vs conventional glucose control multivariable analyses association vulnerability individual treatment state utilities became nonsignificant except cholesterol pill conclusion older patients preferences intensity treatment diabetes mellitus vary widely closely associated vulnerability observation underscores importance involving older patients decisions treatment diabetes mellitus irrespective clinical status