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

...s and Prevention...

...atients aged 65 years and older without known...


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


...ed 65 years and older who have prediabetes, ES...


...able 1. ADA Criteria for PrediabetesaHav...


Assessment

Assessm...

...ll Health Assessment of Older Patients...

...ients aged 65 and older with diabetes, we advise a...

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

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

...2. Clinical Care of Older PeopleHaving troubl...

...ble 3. Conceptual Framework for Considering Over...

.... Tools to Detect Frailty Having trouble view...

...only Employed Measures to Screen f...


Treatment

...eatment...

...ndocrinologist and Diabetes Care Speci...

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


Treatment of Hyperglycemia

...ting Glycemic Targets and Goals...

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

...ssing Glycemia...

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

...yle Interventions...

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

...rug Therapy for Hypergly...

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...g Complications of Diabetes...

...ypertensio...

In patients aged 65 to 85 years with diabetes...

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

...rlipidemia...

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

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

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

...n patients aged 65 years and older with diabetes...

...tive Heart Failure...

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...ed 65 years and older who have diab...

Atheroscler...

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

Eye Complications

...s aged 65 years and older with diabetes,...

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

...ged 65 years and older with diabetes and advanc...

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

...65 years and older with diabetes and peri...

...c Kidney Disease...

...s aged 65 years and older with diabetes w...

...tients aged 65 years and older with diabetes w...

...n patients aged 65 years and older with diabetes...

...ications Used to Treat Hyperglycem...

...nagement of Diabetes Away From Home...

...tients aged 65 years and over with diabetes i...

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

...patients aged 65 years and older without diagnose...