Treatment of Diabetes in Older Adults

Publication Date: March 23, 2019

Key Points

Key Points

Prediabetes is highly prevalent in older people, however, interventions to delay progression from prediabetes to diabetes are especially effective in this age group.

The prevalence of type 2 diabetes increases as individuals age and exaggerates the incidence of both microvascular and macrovascular complications.

Clinicians should perform regular screening for prediabetes and diabetes in the older population and implement interventions as indicated in this guideline.

Given the heterogeneity of the health status of older people with diabetes, the guideline emphasizes shared decision-making and provides a framework to assist health care providers to individualize treatment goals.

The problems that older individuals with diabetes face, in contrast to younger people with the disease, include sarcopenia, frailty and cognitive dysfunction. Such complications can lead to an increased risk of poor medication adherence, hypoglycemia (from certain medications), falls, and loss of independence in daily living activities.

The guideline presents evidence for the various effects of diabetes in the older patients and the relevant therapies for glycemic control, hyperlipidemia and hypertension.

Guideline recommendations also address common co-morbidities such as renal impairment, which affects the pharmacokinetics and pharmacodynamics of specific agents, and concomitant heart disease.

Diagnosis and Prevention

...is and Prevention

...patients aged 65 years and older without known dia...


...atients aged 65 years and older wi...


...s aged 65 years and older who have prediabetes,...


...able 1. ADA Criteria for PrediabetesaHaving...


Assessment

...essment

Overall Health Assessment of Older Patients With D...

...ged 65 and older with diabetes, we advise assess...

...65 years and older with diabetes, ES sugges...

...d 65 years and older with diabetes and a di...

...2. Clinical Care of Older PeopleHaving trouble vi...

...Conceptual Framework for Considering Overall Hea...

...le 4. Tools to Detect Frailty Having troubl...

...monly Employed Measures to Screen for Physica...


Treatment

Treatmen...

...e of the Endocrinologist and Diabete...

...ged 65 years and older with newly diagnos...

...d 65 years and older with diabetes, an...


...eatment of Hyperglyce...

...cemic Targets and Goals...

...ed 65 years and older with diabetes, ES recom...

...sing Glycemia...

...patients aged 65 years and older with di...

...le Interventions

...patients aged 65 years and older wi...

...n patients aged 65 years and older wit...

...aged 65 years and older with diab...

...65 years and older with diabetes who c...

...herapy for Hyperglycemia...

...aged 65 years and older with diabetes, ES recom...

...65 years and older with diabetes who ha...


...ating Complications of Diabetes

...rtension

...65 to 85 years with diabetes, ES recommends a...

...patients aged 65 years and older with diabet...

Hyperlipid...

...ed 65 years and older with diabetes, ES r...

...patients aged 65 years and older with diabetes, ES...

...s aged 65 years and older with diabet...

...ents aged 65 years and older with diabetes an...

Congestive Heart Failur...

...ged 65 years and older who have diabete...

In patients aged 65 years and olde...

...herosclerosis...

...nts aged 65 years and older with diabetes an...

...Complication...

...ents aged 65 years and older with...

...opathy, Falls, and Lower Extremity Problems...

...aged 65 years and older with diabetes and advance...

...patients aged 65 years and older with diabet...

...atients aged 65 years and older with diabetes...

...c Kidney Disease...

...aged 65 years and older with diabetes who are not...

...ts aged 65 years and older with diabetes who are i...

...s aged 65 years and older with diab...

...ions Used to Treat Hyperglycemia and Speci...

...of Diabetes Away From Home – in Hospita...

...atients aged 65 years and over with diabe...

...ents aged 65 years and older with diabetes and...

...ents aged 65 years and older without di...