More than 20% of persons older than 65 years have diabetes.
Older adults with type 2 diabetes have a wide range of clinical and functional differences in diabetes duration, complications, physical and cognitive capability, and life expectancy. They are also at greater risk for common geriatric syndromes, such as polypharmacy, depression, urinary incontinence, injurious falls, and persistent pain.
Intensive diabetes therapy, using the same goals as for younger patients with diabetes, is appropriate for older adult patients who are
functional and cognitively intact
expected to live long enough to reap the benefits of long-term therapy
able to undertake self-management
Treating cardiovascular (CV) risk factors in older adults with diabetes may have greater impact on reducing morbidity and mortality than treating hyperglycemia alone.
Other CV risk factors should be treated in older adults with consideration of the time frame of benefit and the individual patient.
Treatment of hypertension is indicated in virtually all older adults, and lipid and aspirin therapy may benefit those with life expectancy at least equal to the time frame of primary or secondary prevention trials.
Older patients can be treated with the same drug regimens as younger patients, using special care in prescribing and monitoring and starting with the lowest recommended dosages.
Set less-intensive glycemic goals for patients with life-limiting comorbid illness, advanced diabetes complications, and cognitive or functional limitations.
American Diabetes Association. Clinical practice recommendations—2010. Diabetes Care. 2010;33(suppl 1):S42-S43.
