![]() As shown in Table 3, major consideration is given to coexisting severe medical conditions, presence of cognitive dysfunction, and ability to perform day-to-day activities. In this report, glycemic goals are stratified based on patient characteristics and health status. The American Diabetes Association (ADA) in 2012 published a consensus report on managing diabetes in older adults ( 7). For those without other major comorbidities, an A1C goal of 7–7.5% and a fasting glucose target range of 6.5–7.5 mmol/L (117–135 mg/dL) are recommended, whereas for frail older adults and those with multisystem disease, an A1C goal of 7.6–8.5% and a fasting glucose target range of 7.6–9.0 mmol/L (137–162 mg/dL) are recommended to minimize the risk of hypoglycemia and metabolic decompensation. ![]() With regard to glycemic targets, these guidelines divide older adults into two categories. The European Diabetes Working Party for Older People in 2011 published clinical guidelines for treating older adults with diabetes who are ≥70 years of age ( 6). ![]() The details vary by guideline, and these differences are summarized below. Most of these guidelines stress the importance of considering patients’ overall health, comorbidities, cognitive and physical status, hypoglycemia risk, and life expectancy to guide glycemic goal-setting. Several organizations have published guidelines regarding diabetes management in older adults. Most of the discussion in the remainder of this article pertains to community-living older adults.Ĭurrent Guidelines for Diabetes Management in Community-Dwelling Older Adults In such cases, it is important to adjust treatment goals as needed. Another challenge in this population is a higher frequency of acute illnesses and frequent changes in overall health, which can affect glucose control and lead to decline in cognitive functioning and physical status. The goals of diabetes management must differ for older adults based on the presence or absence of these comorbidities, as well as on the patients’ living situation and available resources. In addition, the aging population with diabetes also has a higher risk of other conditions (termed “geriatric syndromes”) that include cognitive dysfunction, depression, physical disability, pain, polypharmacy, and urinary incontinence. However, for others who are unable to follow instructions and manage their own medication regimen, diabetes management can be tricky and dangerous. Some elderly people with diabetes are high functioning and medically stable, can perform self-care, and may or may not need caregivers.
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