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According to the Manafing for Disease Dkabetes and Prevention CDC dabetes, people with diabetes should aim to get half of their total daily calories Managiny carbs. Complex carbohydrates are more diabetes-friendly than simple carbs—since they contain more fiber and other nutrients and are digested more slowly.
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However, loder excess fat can lead to insulin resistance and prolonged high blood sugar levels and negatively affect your Insulin infusion device health. And, since fat Mabaging high in calories, High-intensity workout, eating too much of it can cause weight gain.
What this means for you: Not all fats are created equal. The key is to focus on foods with heart-healthy monounsaturated and polyunsaturated fats—and eat them in moderation. One of the main things to limit on a diabetes eating plan is sugar. Table sugar and even artificial sweeteners cause blood glucose to spike, which can lead to hyperglycemia.
You can prevent this by avoiding sugary foods such as donuts, candy, pastries, soda, and honey. Other foods to eat in moderation when you have diabetes include:. It's important to understand not only what's best to eat when you have diabetes, but also how much to eat.
The Diabetes Plate Method makes it easy to put together healthy meals that help you manage your blood glucose. The first step is using a plate that's about 9" in diameter. Next, imagine your plate is broken up into three sections see diagram below.
Fill half your plate with non-starchy vegetables: These low-carbohydrate vegetables have minimal impact on your blood sugar and are rich in nutrients.
Some examples are:. Fill one-quarter of your plate with lean protein: Lean-protein foods are lower in saturated fat, which is better for your heart. Choose foods such as:. Fill one-quarter of your plate with carbohydrate foods: High-carbohydrate foods have the biggest impact on your blood sugar levels.
Limiting them can help you prevent glucose spikes after meals. These foods include:. Choose water or a low-calorie drink: Water is the best thirst-quencher since it's free of calories and carbs and doesn't raise blood glucose levels. Other beverage options include:.
A diabetes diet plan doesn't have to be restrictive—or dull! By eating wellyou can prevent dramatic blood sugar fluctuations that can potentially lead to major complications. Visit our Diabetes for Older Adults resource library for more smart tips on managing your diabetes.
How Older Adults Can Meet Their Protein Needs, Consumer Reports. We use cookies to give you the best experience on our website.
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Back to Main Menu Professionals Find Content Center for Benefits Access Center for Healthy Aging National Institute of Senior Centers Aging Mastery®. Find us on Social. Diabetes for Older Adults Why It's Important to Eat Healthy When You Have Diabetes May 13, 8 min read. Key Takeaways Good nutrition is an important aspect of managing diabetes in older adults.
Why is it important to eat healthy when you have diabetes? How does diabetes impact senior nutritional needs? Carbohydrates The starches complex carbohydrates and sugars simple carbohydrates in food are converted into blood glucose after we eat them.
Nutrient-dense carbohydrates include: Fruits and vegetables Beans and lentils Whole-grain cereals, breads, and crackers Whole grains such as oats, barley, bulgur, and buckwheat Dried fruit and nuts Protein Protein provides our body with amino acids—the building blocks responsible for building and repairing tissue such as muscle.
Some good lean-protein choices for diabetes management include: Poultry such as chicken and turkey Skinless fish Leaner cuts of beef Tofu Eggs Low-fat dairy, such as cheese and Greek yogurt Nuts and nut butter Pumpkin seeds Beans and legumes, such as black and kidney beans, chickpeas, and lentils Fat There's a common misconception that older adults with diabetes should avoid fat altogether.
These foods include: Avocados Nuts e. What foods should diabetic seniors avoid or limit? Other foods to eat in moderation when you have diabetes include: Refined carbs: These are carbohydrates that have been stripped of their fiber and other vital nutrients. As a result, foods with refined carbs—like white bread—are generally digested faster and can cause glucose levels to rise quickly.
A better bet is to choose foods with complex carbohydrates, such as whole-grain bread. High-fat dairy and animal products: Foods like bacon, sausage, and butter are high in saturated fat, which can cause clogged arteries and heart disease.
Opt instead for lean meats and poultry and an olive oil spread versus butter. Deep-fried foods: As tasty as it may be, fried chicken, French fries, chips, and other fried fare tends to be cooked in unhealthy oils e.
Often, they're coated in breading, which adds excess calories. Choose food that is baked, broiled, or roasted instead of fried. Processed foods: Pre-packaged food, such as TV dinners, cookies, and frozen pizza, are often high in sugar, sodium, and unhealthy fats.
A better option is to prepare your meals using fresh ingredients. Enlist the help of a friend or family member or hire a meal service if you have trouble preparing meals yourself.
Alcoholic beverages: Alcohol can have a negative interaction with medications frequently used to treat diabetes e. Alcoholic drinks may also be high in empty calories and can lead to overeating. Additionally, drinking heavily can cause liver damage and other diabetic health complications.
The bottom line? Consume alcoholic drinks with cautionand know how certain beverages can affect your blood sugar. Drink plenty of water— staying hydrated can prevent you from getting too intoxicated.
It's also a good idea to wear identification such as a MedicAlert bracelet indicating you have diabetes. Intoxication and dangerously low blood sugar are often difficult to tell apart.
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: Managing diabetes in older adults| REVIEW article | Unintentional weight loss in an older adult requires further evaluation. Search ADS. Glucose-lowering medication in type 2 diabetes: Overall approach. Table Furthermore, although LDL-C levels are not necessarily elevated in patients with diabetes, statins still have a profound effect on the prevention of CVD, and thus all patients with T2D should be treated with statins. |
| List of Recommendations | The reported frequency of sulfonylurea-related hypoglycemia in older adults is variable. In an analysis of adverse event data from a drug surveillance project, oral hypoglycemic agents accounted for 10 percent of hospitalizations for adverse drug events [ 49 ]. Long-acting sulfonylureas eg, glyburide should be avoided in older adults due to higher risk of hypoglycemia, especially in individuals with inconsistent timing or content of their meals or those with cognitive decline that prevents prompt recognition or treatment of hypoglycemic episodes [ 50 ]. Drug-induced hypoglycemia may be a limiting factor for sulfonylurea use in older adults and is most likely to occur in the following circumstances:. These issues may arise when there is a change in overall health status in older adults with diabetes. Dual agent failure — For patients who do not achieve A1C goals with two agents eg, metformin plus sulfonylurea or another agent , we suggest starting or intensifying insulin therapy see "Insulin therapy in type 2 diabetes mellitus", section on 'Designing an insulin regimen'. In patients on sulfonylureas and metformin who are starting insulin therapy, sulfonylureas are generally tapered and discontinued, while metformin is continued. Another option is two oral agents and a GLP-1 receptor agonist. It is reasonable to try a GLP-1 agonist before starting insulin in patients who are near glycemic goals, those who prefer to avoid insulin, and those in whom weight loss or avoidance of hypoglycemia is a primary consideration. A once-weekly GLP-1 agonist formulation is particularly attractive for patients and caregivers. However, this option often increases costs and contributes to the problem of polypharmacy in older adults see 'Polypharmacy and deintensification' below. The management of persistent hyperglycemia is reviewed in more detail separately. See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Dual agent failure'. Polypharmacy and deintensification — Use of multiple drugs is common in older adults. Management of hyperglycemia and its associated risk factors often increases the number of medications even more in the older adult with diabetes. Side effects may exacerbate comorbidities and impede patients' ability to manage their diabetes. Therefore, the medication list should be kept current and reviewed at each visit [ 1,6 ]. Overtreatment and complicated regimens should be avoided. Complex regimens that may have been required in the past can often be simplified to be consistent with the modified glycemic targets of an older patient [ 53,54 ]. See 'Controlling hyperglycemia' above. It is important to look for any conditions that interfere with A1C measurement eg, anemia, recent infections, kidney failure, erythropoietin therapy, etc. In these settings or when unexpected or discordant A1C values are encountered, medication adjustments should be based on glucose readings from a glucose meter or continuous glucose monitoring CGM rather than A1C. See "Measurements of chronic glycemia in diabetes mellitus", section on 'Glycated hemoglobin A1C '. However, infrequent or no BGM may be adequate for older patients with type 2 diabetes who are diet treated or who are treated with oral agents not associated with hypoglycemia. The effectiveness of BGM in terms of improving glycemic management in patients with type 2 diabetes is less clear than for type 1 diabetes. See "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus", section on 'Type 2 diabetes'. CGM use also should be considered for older patients with impaired awareness of hypoglycemia, those taking other medications that confer higher risk of hypoglycemia eg, sulfonylureas , and those who have difficulty performing BGM through fingerstick checks due to cognitive or physical limitations. Advances in CGM have made it possible to use the technology in older and even frail patients. Professional CGM devices, applied like a patch on a patient's arm or abdomen depending on the CGM model , measure interstitial glucose levels every 5 to 15 minutes for 10 to 14 days. These devices provide patterns of glucose excursions that can be the foundation for choosing or adjusting insulin doses in patients on multiple daily insulin regimens. These CGM devices are covered by Medicare in qualifying patients. See "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus", section on 'CGM systems'. Retinopathy, nephropathy, and foot problems are all important complications of diabetes mellitus in older patients. Monitoring recommendations for older patients with diabetes are similar to those in younger patients table 3. In particular, complications that impair functional capacity eg, retinopathy, foot problems should be identified and treated promptly [ 12 ]. Retinopathy — The prevalence of retinopathy increases progressively with increasing duration of diabetes figure 2. See "Diabetic retinopathy: Classification and clinical features". Regular eye examinations are extremely important for older patients with diabetes because poor vision can lead to social isolation, an increased risk of accidents, and impaired ability to measure blood glucose and draw up insulin doses. A complete ophthalmologic examination should be performed by a qualified ophthalmologist or optometrist at the time of diagnosis and at least yearly thereafter. The purpose is to screen not only for diabetic retinopathy, but also for cataracts and glaucoma, which are approximately twice as common in older individuals with diabetes compared with those without diabetes [ 55,56 ]. See "Diabetic retinopathy: Screening". Nephropathy — The availability of effective therapy for diabetic nephropathy with angiotensin-converting enzyme ACE inhibitors, angiotensin receptor blockade agents ARBs , mineralocorticoid receptor antagonists, and sodium-glucose co-transport 2 SGLT2 inhibitors has led to the recommendation that all patients with diabetes be screened for increased urinary albumin excretion annually. See "Moderately increased albuminuria microalbuminuria in type 1 diabetes mellitus" and "Moderately increased albuminuria microalbuminuria in type 2 diabetes mellitus". However, the prevalence of increased urinary albumin excretion increases in the older population for reasons unrelated to diabetic nephropathy. For older patients who are already taking an ACE inhibitor or ARB and have progressive decline in glomerular filtration rate GFR or increase in albuminuria, referral to a nephrologist for further evaluation and treatment is warranted. Foot problems — Foot problems are an important cause of morbidity in patients with diabetes, and risk is much higher in older patients. Both vascular and neurologic disease contribute to foot lesions. See "Management of diabetic neuropathy". In addition to the increasing prevalence of neuropathy with age, more than 30 percent of older patients with diabetes cannot see or reach their feet, and they may therefore be unable to perform routine foot inspections. We recommend that older patients with diabetes have their feet examined at every visit; this examination should include an assessment of the patient's ability to see and reach his or her feet and inquiry about other family members or friends who could be trained to do routine foot inspections. Visits to a podiatrist on a regular basis should also be considered if feasible. A detailed neurologic examination and assessment for peripheral artery disease should be performed at least yearly. It is also important that prophylactic advice on foot care be given to any patient whose feet are at high risk. See "Evaluation of the diabetic foot". In addition, they are at high risk for polypharmacy, functional disabilities, and other common geriatric syndromes that include cognitive impairment, depression, urinary incontinence, mobility impairment, falls, and persistent pain [ 1 ]. See "Comprehensive geriatric assessment". All older adults should undergo screening for mild cognitive impairment or dementia at initial evaluation and, thereafter, annually or as appropriate for the individual patient [ 12 ]. Despite limited treatment options, identification of underlying cognitive impairment is critical for assessing a patient's capacity to self-manage diabetes treatment and care. In particular, cognitive function and the possibility of depression should be assessed in older patients with diabetes when any of the following are present see "Evaluation of cognitive impairment and dementia" and "Screening for depression in adults" :. Nursing home patients — Few studies have focused on management of older adults with diabetes residing in nursing homes [ 4 ]. Life expectancy, quality of life, severe functional disabilities, and other coexisting conditions affect goal setting and management plans. See 'Controlling hyperglycemia' above and 'Avoiding hypoglycemia' above. Treatment regimens should be chosen with a focus on avoidance of hypoglycemia and control of hyperglycemic symptoms [ 17 ]. For patients requiring insulin, metformin combined with once-daily basal insulin is an effective, relatively simple regimen. If prandial insulin is necessary, it can be administered immediately after a meal to better match the meal size and minimize hypoglycemia. Sliding scale insulin should not be used as a sole means of providing insulin. If a patient is temporarily managed with sliding scale insulin to determine the requisite dose s of insulin therapy, a more physiologic glucose control strategy should be implemented within a few days table 4. End-of-life care — Management of patients with diabetes at the end of life must be tailored to individual needs and the severity of the illness. In general, the risks and consequences of hypoglycemia are greater than those of hyperglycemia in patients at the end of life. The goal is to avoid extreme hyperglycemia and dehydration as well as excessive treatment burdens such as multiple insulin injections or intensive monitoring. For patients with type 2 diabetes who are no longer taking anything by mouth, discontinuation of diabetes medications is reasonable [ 59 ]. This is in contrast to patients with type 1 diabetes, in whom continuing a small amount of basal insulin is required to prevent iatrogenic acute hyperglycemia and ketoacidosis. See "Palliative care: The last hours and days of life", section on 'Eliminating non-essential medications' and "Deprescribing", section on 'Glucose-lowering medications'. SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Diabetes mellitus in adults". Older adults with diabetes are a heterogeneous population that includes persons residing independently in communities, in assisted care facilities, or in nursing homes. They can be fit and healthy, or frail with many comorbidities and functional disabilities. Therefore, older adults in particular require individualized goals for diabetes management, keeping in mind their limited life expectancy and comorbidities. See 'Goals' above. Thus, avoidance of hypoglycemia is an important consideration in establishing goals and choosing therapeutic agents in older adults. See 'Avoiding hypoglycemia' above and "Hypoglycemia in adults with diabetes mellitus", section on 'Strategies to manage hypoglycemia'. See 'Cardiovascular risk reduction' above. The nutrition prescription is tailored for older people with diabetes based upon medical, lifestyle, and personal factors. Exercise is beneficial to help maintain physical function, reduce cardiac risk, and improve body composition and insulin sensitivity in older patients with diabetes. See 'Lifestyle modification' above. Because of concern for hypoglycemia, some clinicians use insulin only for a short time to ameliorate glucose toxicity. Once insulin secretion and sensitivity are improved, it may be possible to lower the dose or replace insulin with metformin or another oral hypoglycemic agent with lower risk of hypoglycemia. See 'Choice of initial drug' above. Metformin will likely reduce glycemia safely at any level of hyperglycemia and further may reduce progression of hyperglycemia or the risk of developing diabetes-related complications. See 'Metformin' above. An alternative option for patients who present with A1C near their medication-treated target and who prefer to avoid medication is a three- to six-month trial of lifestyle modification before initiating metformin. The approach to choosing alternative therapy in metformin-intolerant patients is similar in older and younger adults. See 'Contraindications to metformin' above and "Initial management of hyperglycemia in adults with type 2 diabetes mellitus", section on 'Contraindications to or intolerance of metformin'. The therapeutic options for patients who do not reach glycemic goals with lifestyle intervention and metformin are similar in older and younger patients. All of the medications have advantages and disadvantages table 2. The choice of a second agent should be individualized based upon efficacy, risk of hypoglycemia, the patient's underlying comorbidities, the impact on weight, side effects, and cost figure 1. See 'Persistent hyperglycemia' above and "Management of persistent hyperglycemia in type 2 diabetes mellitus". Another option is two oral agents and a glucagon-like peptide 1 GLP-1 receptor agonist. See 'Dual agent failure' above. In particular, complications that impair functional capacity eg, retinopathy, foot problems should be identified and treated promptly. See 'Screening for microvascular complications' above. Cognitive function should be assessed routinely in older adults with diabetes. Unexplained deterioration in glycemia or nonadherence to diabetes care may reflect underlying depression. See 'Common geriatric syndromes associated with diabetes' above. Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Treatment of type 2 diabetes mellitus in the older patient. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. View in. Language Chinese English. Author: Medha Munshi, MD Section Editors: David M Nathan, MD Kenneth E Schmader, MD Deputy Editors: Katya Rubinow, MD Jane Givens, MD, MSCE Contributor Disclosures. All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Jan 04, Diabetes in older adults: a consensus report. J Am Geriatr Soc ; Thorpe CT, Gellad WF, Good CB, et al. Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia. Diabetes Care ; Lipska KJ, Krumholz H, Soones T, Lee SJ. Polypharmacy in the Aging Patient: A Review of Glycemic Control in Older Adults With Type 2 Diabetes. JAMA ; Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes, a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia ; Sinclair AJ, Paolisso G, Castro M, et al. European Diabetes Working Party for Older People clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab ; 37 Suppl 3:S Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults. International Diabetes Federation. pdf Accessed on February 24, American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus, Moreno G, Mangione CM, et al. Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: update. 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Deintensification of hypoglycaemic medications-use of a systematic review approach to highlight safety concerns in older people with type 2 diabetes. Diabetes Complicat. Alwhaibi M, Balkhi B, Alhawassi TM, Alkofide H, Alduhaim N, Alabdulali R, et al. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open 8:e Peron EP, Ogbonna KC, Donohoe KL. Antidiabetic medications and polypharmacy. Munshi MN. Cognitive dysfunction in older adults with diabetes: what a clinician needs to know. Diabetes Care —7. Majumdar SR, Hemmelgarn BR, Lin M, McBrien K, Manns BJ, Tonelli M. Hypoglycemia associated with hospitalization and adverse events in older people: population-based cohort study. Kagansky N, Levy S, Rimon E, Cojocaru L, Fridman A, Ozer Z, et al. Hypoglycemia as a predictor of mortality in hospitalized elderly patients. Arch Intern Med. Migdal A, Yarandi SS, Smiley D, Umpierrez GE. Update on diabetes in the elderly and in nursing home residents. J Am Med Dir Assoc. Huang CC, Weng SF, Tsai KT, Chen PJ, Lin HJ, Wang JJ, et al. Long-term mortality risk after hyperglycemic crisis episodes in geriatric patients with diabetes: a national population-based cohort study. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. Palta P, Huang ES, Kalyani RR, Golden SH, Yeh H-C. Hemoglobin A1C and mortality in older adults with and without diabetes: results from the National Health and Nutrition Examination Surveys — Abbasi J. For patients with type 2 diabetes, what's the best target hemoglobin A1C? JAMA —9. Lee SJ, Eng C. Goals of glycemic control in frail older patients with diabetes. JAMA —1. Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the american association of clinical endocrinologists and american college of endocrinology on the comprehensive type 2 diabetes management algorithm - executive summary. Endocr Pract. Qaseem A, Wilt TJ, Kansagara D, Horwitch C, Barry MJ, Forciea MA, et al. Hemoglobin A1c Targets for glycemic control with pharmacologic therapy for non-pregnant adults with type 2 diabetes mellitus: a guidance statement update from the American college of physicians. Ann Intern Med. Giugliano D, Maiorino MI, Bellastella G, Esposito K. Dissonance among treatment algorithms for hyperglycemia in type 2 diabetes: an egalitarian dialog. J Endocrinol Invest. McLaren LA, Quinn TJ, McKay GA. Diabetes control in older people. BMJ f Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of Hyperglycemia in type 2 diabetes, a consensus report by the American Diabetes Association ADA and the European association for the study of diabetes EASD. Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. Lipska KJ, Bailey CJ, Inzucchi SE. Use of metformin in the setting of mild-to-moderate renal insufficiency. Wilcox R, Kupfer S, Erdmann E. Effects of pioglitazone on major adverse cardiovascular events in high-risk patients with type 2 diabetes: results from PROspective pioglitAzone clinical trial in macro vascular events PROactive Am Heart J. Schneider CA, Ferrannini E, Defronzo R, Schernthaner G, Yates J, Erdmann E. Effect of pioglitazone on cardiovascular outcome in diabetes and chronic kidney disease. J Am Soc Nephrol. Viscoli CM, Inzucchi SE, Young LH, Insogna KL, Conwit R, Furie KL, et al. Pioglitazone and risk for bone fracture: safety data from a randomized clinical trial. Lewis JD, Habel LA, Quesenberry CP, Strom BL, Peng T, Hedderson MM, et al. Pioglitazone use and risk of bladder cancer and other common cancers in persons with diabetes. Yakaryılmaz FD, Öztürk ZA. Treatment of type 2 diabetes mellitus in the elderly. World J Diabetes — Omori K, Nomoto H, Nakamura A, Takase T, Cho KY, Ono K, et al. Reduction in glucose fluctuations in elderly patients with type 2 diabetes using repaglinide: a randomized controlled trial of repaglinide vs. J Diabetes Investig. Inzucchi SE, Nauck MA, Hehnke U, Woerle HJ, von Eynatten M, Henry RR. Improved glucose control with reduced hypoglycaemic risk when linagliptin is added to basal insulin in elderly patients with type 2 diabetes. Barnett AH, Huisman H, Jones R, von Eynatten M, Patel S, Woerle HJ. Linagliptin for patients aged 70 years or older with type 2 diabetes inadequately controlled with common antidiabetes treatments: a randomised, double-blind, placebo controlled trial. Esposito K, Chiodini P, Maiorino MI, Capuano A, Cozzolino D, Petrizzo M, et al. A nomogram to estimate the HbA1c response to different DPP-4 inhibitors in type 2 diabetes: a systematic review and meta-analysis of 98 trials with 24 patients. BMJ Open 5:e Rizzo MR, Barbieri M, Fava I, Desiderio M, Coppola C, Marfella R, et al. Sarcopenia in elderly diabetic patients: role of dipeptidyl peptidase 4 inhibitors. Nauck MA, Meier JJ, Cavender MA, Abd El Aziz M, Drucker DJ. Cardiovascular actions and clinical outcomes with glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors. Circulation — White WB, Cannon CP, Heller SR, Nissen SE, Bergenstal RM, Bakris GL, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. Green JB, Bethel MA, Armstrong PW, Buse JB, Engel SS, Garg J, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. Rosenstock J, Perkovic V, Johansen OE, Cooper ME, Kahn SE, Marx N, et al. Effect of linagliptin vs. placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk-The Carmelina Randomized clinical trial. Scirica BM, Braunwald E, Raz I, Cavender MA, Morrow DA, Jarolim P, et al. Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. Zannad F, Cannon CP, Cushman WC, Bakris GL, Menon V, Perez AT, et al. Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomised, double-blind trial. Bethel MA, Engel SS, Green JB, Huang Z, Josse RG, Kaufman KD, et al. Assessing the safety of sitagliptin in older participants in the trial evaluating cardiovascular outcomes with sitagliptin TECOS. Josse RG, Majumdar SR, Zheng Y, Adler A, Bethel MA, Buse JB, et al. Sitagliptin and risk of fractures in type 2 diabetes: results from the TECOS trial. Sesti G, Antonelli Incalzi R, Bonora E, Consoli A, Giaccari A, Maggi S, et al. Management of diabetes in older adults. Nutr Metab Cardiovasc Dis. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. Neal B, Perkovic V, Mahaffey KW, De Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. Birkeland KI, Jørgensen ME, Carstensen B, Persson F, Gulseth HL, Thuresson M, et al. Cardiovascular mortality and morbidity in patients with type 2 diabetes following initiation of sodium-glucose co-transporter-2 inhibitors versus other glucose-lowering drugs CVD-REAL Nordic : a multinational observational analysis. Lancet Diabetes Endocrinol. Wanner C, Inzucchi SE, Lachin JM, Fitchett D, von Eynatten M, Mattheus M, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. Perkovic V, De Zeeuw D, Mahaffey KW, Fulcher G, Erondu N, Shaw W, et al. Canagliflozin and renal outcomes in type 2 diabetes: results from the CANVAS Program randomised clinical trials. Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. FDA Drug Safety Communication. FDA Warns That SGLT2 Inhibitors for Diabetes May Result in a Serious Condition of Too Much Acid in the Blood. htm Accessed May 15, Fralick M, Schneeweiss S, Patorno E. Risk of diabetic ketoacidosis after initiation of an SGLT2 inhibitor. Peters AL, Buschur EO, Buse JB, Cohan P, Diner JC, Hirsch IB. Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium-glucose cotransporter 2 inhibition. Neal B, Perkovic V, Matthews DR. Watts NB, Bilezikian JP, Usiskin K, Edwards R, Desai M, Law G, et al. Effects of canagliflozin on fracture risk in patients with type 2 diabetes mellitus. J Clin Endocrinol Metabol. Esposito K, Mosca C, Brancario C, Chiodini P, Ceriello A, Giugliano D. Curr Med Res Opin. Abd El Aziz MS, Kahle M, Meier JJ, Nauck MA. A meta-analysis comparing clinical effects of short- or long-acting GLP-1 receptor agonists versus insulin treatment from head-to-head studies in type 2 diabetic patients. Meneilly GS, Roy-Duval C, Alawi H, Dailey G, Bellido D, Trescoli C, et al. Lixisenatide therapy in older patientswith type 2 diabetes inadequately controlled on their current antidiabetic treatment: the GetGoal-O randomized trial. Bettge K, Kahle M, Abd El Aziz MS, Meier JJ, Nauck MA. Occurrence of nausea, vomiting and diarrhoea reported as adverse events in clinical trials studying glucagon-like peptide-1 receptor agonists: a systematic analysis of published clinical trials. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. Hernandez AF, Green JB, Janmohamed S, D'Agostino RB Sr, Granger CB, Jones NP, et al. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease Harmony Outcomes : a double-blind, randomised placebo-controlled trial. McClean PL, Holscher C. Neuropharmacology — Bomba M, Granzotto A, Castelli V, Massetti N, Silvestri E, Canzoniero LMT, et al. Exenatide exerts cognitive effects by modulating the BDNF-TrkB neurotrophic axis in adult mice. Neurobiol Aging — Pharmacologic approaches to glycemic treatment. In standards of medical care in diabetes. Diabetes Care S64— Food and Drug Administration, Center for Drug Evaluation and Research. NDA Approval Letter, November 21, cfm Accessed November 10, ; U. NDA approval letter, November 21, cfm Accessed November 10, Rosenstock J, Handelsman Y, Vidal J, Ampudia Blasco FJ, Giorgino F, Liu M, et al. Propensity-score-matched comparative analyses of simultaneously administered fixed-ratio insulin glargine U and lixisenatide iGlarLixi vs. sequential administration of insulin glargine and lixisenatide in uncontrolled type 2 diabetes. Maiorino MI, Chiodini P, Bellastella G, Capuano A, Esposito K, Giugliano D. Insulin and glucagon-like peptide 1 receptor agonist combination therapy in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Maiorino MI, Chiodini P, Bellastella G, Scappaticcio L, Longo M, Esposito K, et al. Free and fixed-ratio combinations of basal insulin and GLP-1 receptor agonists versus basal insulin intensification in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Esposito K, Chiodini P, Bellastella G, Maiorino MI, Giugliano D. Maiorino MI, Petrizzo M, Capuano A, Giugliano D, Esposito K. The development of new basal insulins: is there any clinical advantage with their use in type 2 diabetes? 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| Treatment of type 2 diabetes mellitus in the older patient - UpToDate | You can also check out the Emotional Support articles and blogs. Read more about loneliness and diabetes. Ask someone to help you to get to your diabetes-related health care appointments. Some communities provide free or low-cost transportation services to seniors who are no longer able to drive. If getting to the grocery store or preparing meals is a challenge for you, there are also meal delivery services in some areas. Burnout Can Be Defeated. Share on Facebook Share on Twitter Share on Linked In Share by Email. Maintaining A Healthy Weight Why Is It Important. Sign up for our newsletter! We are here to help! Diabetes Care Community Newsletters Living Well with Diabetes. Your privacy is important to us. Skip to primary navigation Skip to main content Skip to primary sidebar Skip to footer Self-management News Educational videos. Home » About Diabetes » Diabetes and Seniors. Diagnosis and management The diagnosis and management of diabetes in elderly people generally defined as those over 65 years of age is similar to other people, in many respects. Medication use In elderly people who need medication to manage their diabetes, the use of drug therapy is much the same as the general population with diabetes. Medication management If you are an elderly person who is taking many medications — for diabetes as well as other conditions — it can be a challenge to remember to take them all, on different schedules. Blood glucose targets The recommended targets for the elderly are the same as for the general population. Hypoglycemia Elderly people are at higher risk of hypoglycemia. Some of the more common factors that can cause hypoglycemia include: Numerous prescription medications i. Economic issues If financial concerns are preventing you from being able to obtain required medications and supplies, appropriate nutrition or other diabetes services, there may be some provincial financial assistance programs available specifically for senior citizens. Loneliness and isolation Find a diabetes support group in your community if you are concerned about your emotional health — feeling overwhelmed, lonely or depressed. Driving limitations Ask someone to help you to get to your diabetes-related health care appointments. Strategies that combine physical activity with nutrition therapy to promote weight loss may result in improved physical performance and function and reduced cardiometabolic risk in older adults 86 , When communicating with cognitively impaired patients, educators should address the patient by name even when a caregiver will provide most care , speak in simple terms, use signals cues that aid memory verbal analogies, hands-on experience, demonstrations and models , and utilize strategies such as sequenced visits to build on information. Other tactics include summarizing important points frequently, focusing on one skill at a time, teaching tasks from simple to complex, and providing easy-to-read handouts. Even in the absence of cognitive impairment, educators should consider that many patients may have low health literacy and numeracy skills or may be overwhelmed by the presence of multiple comorbidities. Muscle mass and strength decline with age, and these decrements may be exacerbated by diabetes complications, comorbidities, and periods of hospitalization in older adults with diabetes. People with diabetes of longer duration and those with higher A1C have lower muscle strength per unit of muscle mass than BMI- and age-matched people without diabetes and than those whose disease is of shorter duration or under better glycemic control Although age and diabetes conspire to reduce fitness and strength, physical activity interventions improve functional status in older adults 91 with and without diabetes. In older adults, even light-intensity physical activity is associated with higher self-rated physical health and psychosocial well-being Older adults with diabetes who are otherwise healthy and functional should be encouraged to exercise to targets recommended for all adults with diabetes Even patients with poorer health status benefit from modest increases in physical activity. Tactics to facilitate activity for older adults may include referring to supervised group exercise and community resources such as senior centers, YMCAs, the EnhanceFitness program, and the resources of the Arthritis Foundation. Older patients are at increased risk for adverse drug events from most medications due to age-related changes in pharmacokinetics in particular reduced renal elimination and pharmacodynamics increased sensitivity to certain medications affecting drug disposition. These changes may translate into increased risk for hypoglycemia, the potential need for reduced doses of certain medications, and attention to renal function to minimize side effects 94 , The risk for medication-related problems is compounded by the use of complex regimens, high-cost therapies, and polypharmacy or medication burden. Collectively, these factors should be considered and weighed against the expected benefits of a therapy before incorporating it into any therapeutic plan. Attention to the selection of medications with a strong benefit-to-risk ratio is essential to promote efficacy, persistence on therapy, and safety. Comparative effectiveness studies of medications to treat diabetes in older adult populations are lacking. Type 2 diabetes with onset later in life is characterized by prominent defects in β-cell function, suggesting therapeutic attention to β-cell function and sufficiency of insulin release, as well as the traditional focus on hepatic glucose overproduction and insulin resistance. Understanding the advantages and disadvantages of each antihyperglycemic drug class helps clinicians individualize therapy for patients with type 2 diabetes Issues particularly relevant to older patients are described for each drug class. Metformin is often considered the first-line therapy in type 2 diabetes. Its low risk for hypoglycemia may be beneficial in older adults, but gastrointestinal intolerance and weight loss from the drug may be detrimental in frail patients. Despite early concerns, the evidence for an increase in the risk of lactic acidosis with metformin is minimal. Sulfonylureas are also a low-cost class of medications, but the risk of hypoglycemia with these agents may be problematic for older patients. Glyburide has the highest hypoglycemia risk and should not be prescribed for older adults Glinides are dosed prior to meals, and their short half-life may be useful for postprandial hyperglycemia. They impart a lower risk for hypoglycemia than sulfonylureas, especially in patients who eat irregularly, but their dosing frequency and high cost may be barriers. α-Glucosidase inhibitors specifically target postprandial hyperglycemia and have low hypoglycemia risk, making them theoretically attractive for older patients. However, gastrointestinal intolerance may be limiting, frequent dosing adds to regimen complexity, and this class of medications is costly. Thiazolidinediones have associated risks of weight gain, edema, heart failure, bone fractures, and possibly bladder cancer, which may argue against their use in older adults. The use of rosiglitazone is now highly restricted. The class has traditionally been expensive, although the approval of generic pioglitazone may reduce its cost. Dipeptidyl peptidase-4 inhibitors are useful for postprandial hyperglycemia, impart little risk for hypoglycemia, and are well tolerated, suggesting potential benefits for older patients. However, their high cost may be limiting. Glucagon-like peptide-1 agonists also target postprandial hyperglycemia and impart low risk of hypoglycemia, but their associated nausea and weight loss may be problematic in frail older patients. Injection therapy may add to regimen complexity, and its very high cost may be problematic. For some agents, dose reduction is required for renal dysfunction. Insulin therapy can be used to achieve glycemic goals in selected older adults with type 2 diabetes with similar efficacy and hypoglycemia risk as in younger patients. However, given the heterogeneity of the older adult population, the risk of hypoglycemia must be carefully considered before using an insulin regimen to achieve an aggressive target for hyperglycemia control. The addition of long-acting insulin was similarly effective in achieving A1C goals for older patients with type 2 diabetes mean age 69 years in a series of trials with no greater rates of hypoglycemia than in younger patients mean age 53 years Problems with vision or manual dexterity may be barriers to insulin therapy for some older adults. Pen devices improve ease of use but are more costly than the use of vials and syringes. Hypoglycemia risk especially nocturnal is somewhat lower with analog compared with human insulins, but the former are more expensive. Insulin-induced weight gain is a concern for some patients, and the need for more blood glucose monitoring may increase treatment burden. Other approved therapies for which there is little evidence in older patients include colesevelam, bromocriptine, and pramlintide. An emerging drug class, sodium-glucose cotransporter-2 inhibitors, may require additional study in older adults to assess whether drug-associated genital infections or urinary incontinence is problematic in this population. Age appears to affect counter-regulatory responses to hypoglycemia in nondiabetic individuals. Studies in older individuals with diabetes are limited. One small study compared responses to hypoglycemic clamps in older mean age 70 years versus middle-aged mean age 51 years people with type 2 diabetes. Hormonal counter-regulatory responses to hypoglycemia did not differ between age-groups, but middle-aged participants had a significant increase in autonomic and neuroglycopenic symptoms at the end of the hypoglycemic period, while older participants did not. Half of the middle-aged participants, but only 1 out of 13 older participants, correctly reported that their blood glucose was low during hypoglycemia In a population analysis of Medicaid enrollees treated with insulin or sulfonylureas, the incidence of serious hypoglycemia defined as that leading to emergency department visit, hospitalization, or death was approximately 2 per person-years , but clearly studies based on administrative databases miss less catastrophic hypoglycemia. The risk factors for hypoglycemia in diabetes in general use of insulin or insulin secretagogues, duration of diabetes, antecedent hypoglycemia, erratic meals, exercise, renal insufficiency presumably apply to older patients as well. In the Medicaid study cited above, independent risk factors included hospital discharge within the prior 30 days, advanced age, black race, and use of five or more concomitant medications Assessment of risk factors for hypoglycemia is an important part of the clinical care of older adults with hypoglycemia. Education of both patient and caregiver on the prevention, detection, and treatment of hypoglycemia is paramount. Although attention has rightly been paid to the risks of overtreatment of hyperglycemia in older adults hypoglycemia, treatment burden, possibly increased mortality , untreated or undertreated hyperglycemia also has risks, even in patients with life expectancy too short to be impacted by the development of chronic complications. Hyperglycemic hyperosmolar syndrome is a particularly severe complication of unrecognized or undertreated hyperglycemia in older adults. Although it is appropriate to relax glycemic targets for older patients with a history of hypoglycemia, a high burden of comorbidities, and limited life expectancy, goals that minimize severe hyperglycemia are indicated for almost all patients. A central concept in geriatric diabetes care guidelines is that providers should base decisions regarding treatment targets or interventions on life expectancy 2 , 17 , 56 , Patients whose life expectancy is limited e. An observation supporting this concept is that cumulative event curves for the intensive and conventional glycemic control arms of the UKPDS separated after the 9-year mark. National Vital Statistics life table estimates of average life expectancy for adults of specific ages, sexes, and races may not apply to older adults with diabetes, who have shorter life expectancies than the average older adult. Mortality prediction models that account for variables such as comorbidities and functional status can serve as the basis for making more refined life expectancy estimates — Mortality prediction models specific to diabetes exist but were not designed to inform treatment decisions , A limitation of existing mortality models is that they can help to rank patients by probability of death, but these probabilities must still be transformed into a life expectancy for a particular older diabetic patient. Simulation models can help transform mortality prediction into a usable life expectancy. One such model estimated the benefits of lowering A1C from 8. A combination of multiple comorbid illnesses and functional impairments was a better predictor of limited life expectancy and diminished benefits of intensive glucose control than age alone. This model suggests that life expectancy averages less than 5 years for patients aged 60—64 years with seven additional index points points due to comorbid conditions and functional impairments , aged 65—69 years with six additional points, aged 70—74 years with five additional points, and aged 75—79 years with four additional points. An example of comorbid illnesses is the diagnosis of cancer, which confers two points, whereas an example of a functional impairment is the inability to bathe oneself, conferring two points. In light of the paucity of data for diabetes care in older adults, treatment decisions are frequently made with considerable uncertainty. Shared decision making has been advocated as an approach to improving the quality of these so-called preference-sensitive medical decisions , Key components of the shared decision-making approach are 1 establishing an ongoing partnership between patient and provider, 2 information exchange, 3 deliberation on choices, and 4 deciding and acting on decisions When asked about their health care goals, older diabetic patients focus most on their functional status and independence A key component of improving communication in the clinical setting may be finding congruence between patient goals and the biomedical goals on which clinicians tend to focus. Thus, providers must first educate patients and their caregivers about what is known about the role of risk factors in the development of complications and then discuss the possible harms and benefits of interventions to reduce these risk factors. Equally important is discussing the actual medications that may be needed to achieve treatment goals because patients may have strong preferences about the treatment regimen. In a study of patient preferences regarding diabetes complications and treatments, end-stage complications had the greatest perceived burden on quality of life; however, comprehensive diabetes treatments had significant negative perceived quality-of-life effects, similar to those of intermediate complications Preferences for each health state varied widely among patients, and this variation was not related to health status , implying that the preferences of an individual patient cannot be assumed to be known based on health status. Many older adults rely on family members or friends to help them with their treatment decisions or to implement day-to-day treatments. In the case of the older person with cognitive deficits, the family member or friend may in fact be serving as a surrogate decision maker. Among older adults, African Americans and Hispanics have higher incidence and prevalence of type 2 diabetes than non-Hispanic whites, and those with diagnosed diabetes have worse glycemic control and higher rates of comorbid conditions and complications The Institute of Medicine found that although health care access and demographic variables account for some racial and ethnic disparities, there are persistent, residual gaps in outcomes attributed to differences in the quality of care received There is clearly a need for more research into the disparities in diabetes, particularly to understand the full impact of quality improvement programs and culturally tailored interventions among vulnerable older adults with diabetes. Long-term care LTC facilities include nursing homes, which provide h nursing care for patients in either residential care or rehabilitative care, and adult family homes where the level of care is not as acute. LTC residents with diabetes have more falls , higher rates of CVD and depression, more functional impairment, and more cognitive decline and dependency than residents without diabetes The LTC facility resident may have irregular and unpredictable meal consumption, undernutrition, anorexia, and impaired swallowing. Therapeutic diets may inadvertently lead to decreased food intake and contribute to unintentional weight loss and undernutrition. Vulnerable older adults, particularly those with cognitive dysfunction, may have impaired thirst sensation, contributing to the risk of volume depletion and hyperglycemic crises. Precipitating situations include illness, institutional settings LTC or hospital , aversion to drinking water, dysphasia requiring thickened liquids, and some medications Fluid intake should be encouraged and monitored in an institutional setting. A major issue in LTC facilities is frequent staff turnover with resultant unfamiliarity with vulnerable residents There is often inadequate oversight of glycemic control related to infrequent review of glycemic trends, complex and difficult-to-read glucose logs, and lack of specific diabetes treatment algorithms including glycemic parameters for provider notification Excessive reliance on sliding-scale insulin SSI has been documented. Evidence-based policies for glycemic control, use of insulin, and treatment of hypoglycemia have the potential to improve the care of residents with diabetes, alleviate some of the burden caused by frequent staff turnover, and even lead to more staff satisfaction. Older adults are more apt to require hospitalization than younger adults, and those with diabetes are at very high risk of requiring hospitalization. There is a dearth of studies addressing older adults with diabetes, particularly more frail older adults, in the hospital. Many guidelines that apply to hospitalized adults with hyperglycemia can probably be extrapolated to older adults , Less stringent glycemic targets may be appropriate for patients with multiple comorbidities and reduced life expectancy—criteria that could be applicable to many hospitalized older adults. Studies of glycemic control targets in critically ill patients did include older adults, and therefore the recommendations for insulin infusions and glycemic goals of the ADA 17 are reasonable for older adults in intensive care units. Other recommendations for all adults, such as avoiding the use of sliding scale—only regimens and noninsulin antihyperglycemic drugs, are also reasonable for hospitalized older adults. Transitions from hospital to home or to short- or long-term care facilities are times of risk for patients with diabetes, and probably more so for older patients. Older patients on insulin may need to increase or decrease their dose as they recuperate from their acute illness and their diet improves. Delirium acute decline in cognitive function is a common complication seen in older adults during and after hospitalization and may require more supervision to avoid errors in dosing. Medication reconciliation, patient and caregiver education, and close communication between inpatient and outpatient care teams, are critically important to ensure patient safety and reduce readmission rates. After review of the available evidence and consideration of issues that might influence treatment decisions in older adults with diabetes, the authors have developed recommendations in a number of areas. Table 1 provides a framework for considering treatment goals for glycemia, blood pressure, and dyslipidemia. This framework is based on the work of Blaum et al. The three classes correspond with increasing levels of mortality risk The observation that there are three major classes of older diabetic patients is supported by other research The framework is an attempt to balance the expected time frame of benefit of interventions with anticipated life expectancy. Table 2 provides additional consensus recommendations beyond goals of treatment of glycemia, blood pressure, and dyslipidemia. A framework for considering treatment goals for glycemia, blood pressure, and dyslipidemia in older adults with diabetes. The exclusion of older, and especially frail older, participants from most traditional randomized controlled trials of diabetes interventions has left us with large gaps in our knowledge of how best to address diabetes in the age-group with the highest prevalence rates. Future research should allow and account for the complexity and heterogeneity of older adults. Studies will need to include patients with multiple comorbidities, dependent living situations, and geriatric syndromes in order to advance our knowledge about these populations. Suggested research questions and topics are listed in Table 3. The ADA thanks the following individuals for their excellent presentations at the Consensus Development Conference on Diabetes and Older Adults: Edward Gregg, PhD; Nicolas Musi, MD; M. Miller, PhD; R. Harsha Rao, MD, FRCP; Craig Williams, PharmD, BCPS, FNLA; Barbara Resnick, PhD, CRNP, FAAN, FAANP; Carol M. Mangione, MD, MSPH; Jill P. Crandall, MD; Caroline S. Blaum, MD, MS; Jeff D. Williamson, MD, MHS; John M. Jakicic, PhD; Tamara Harris, MD, MS; and Naushira Pandya, MD, CMD. The authors thank Bobbie Alexander, Monique Lindsy, and Earnestine Walker for their assistance with the consensus development conference. The consensus development conference was supported by a planning grant from the Association of Subspecialty Professors though a grant from the John A. Hartford Foundation , by educational grants from Lilly USA, LLC and Novo Nordisk, and sponsorships from the Medco Foundation and Sanofi. Sponsors had no influence on the selection of speakers or writing group members, topics and content presented at the conference, or the content of this report. Pepper Older Americans Independence Center P30 AG receives speaking honoraria from Sanofi. chairs a Data Monitoring Committee for Takeda Global Research and Development for studies of a new dipeptidyl peptidase-4 inhibitor. receives grant support from Sanofi and has served as a consultant to Regeneron. receives grant support from Sanofi. No other potential conflicts of interest relevant to this article were reported. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 35, Issue Previous Article Next Article. What is the epidemiology and pathogenesis of diabetes in older adults? What current guidelines exist for treating diabetes in older adults? What issues need to be considered in individualizing treatment recommendations for older adults? What are consensus recommendations for clinicians treating older adults with or at risk for diabetes? How can gaps in the evidence best be filled? Article Navigation. Consensus Report November 14 Diabetes in Older Adults M. Sue Kirkman, MD ; M. Sue Kirkman, MD. From 1 Medical Affairs and Community Information, American Diabetes Association, Alexandria, Virginia; the. The extra sugar that builds up damages your body parts. People with type 1 usually develop diabetes in childhood or as teenagers. Being overweight is also associated with developing diabetes. Q: What is different for older adults with diabetes compared to younger people? A: Having diabetes increases the chance of having heart attacks, strokes, kidney or eye problems, which makes it an especially challenging disease for older adults to manage. If you have diabetes, chances are your healthcare provider is also treating you for other problems, such as high blood pressure or high cholesterol. And that means you could be taking several different medications, and need to be followed carefully to make sure that all these medications are working safely together. Older people with diabetes also may have trouble with depression, memory loss, urinary incontinence, falls, poor vision, and persistent pain. The good news is that all of these problems can be treated by your healthcare provider, so be sure to talk to them about it. A: Control of blood sugar is important in preventing or delaying problems from diabetes. Blood glucose levels can be checked to make sure that control is achieved. Everyone with diabetes needs their blood sugar checked. Your healthcare provider will do this using two tests. |
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Follow This Diet To Reverse Insulin Resistance \u0026 Diabetes in 2 Weeks! Type 2 diabetes management in older people can be complex due to the wide variations Manabing co-morbidities, physical and cognitive impairment, and life kn. Less Balanced Nutrition for Performance Enhancement treatment targets are appropriate when High-intensity workout Managijg of Diaberes management diabftes the benefits. The prevalence Managing diabetes in older adults type 2 diabetes increases markedly with age. The health status of people with type 2 diabetes often becomes more complex over time and can lead to a shift in the balance between the benefits and harms of maintaining very stringent glycaemic targets, e. Factors such as the onset or worsening of co-morbidities, physical and cognitive impairment, frailty, age-related physiological changes, social isolation, loss of independence and depression can affect diabetes management in various ways, including:. multiple oral glucose-lowering medicines, monitoring blood glucose levels, adjusting insulin doses, administering insulin injections.
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