Treatment of Diabetes in Older Adults Guideline Resources

Full Guideline: Treatment of Diabetes in Older Adults
JCEM: May 2019 (online March 2019)

Derek LeRoith, Geert Jan Biessels, Susan S. Braithwaite, Felipe F. Casanueva, Boris Draznin, Jeffrey B. Halter, Irl B. Hirsch, Marie E. McDonnell, Mark E. Molitch, M. Hassan Murad, and Alan J. Sinclair

The 2019 guideline on treatment of diabetes in older adults:

  • Provides recommendations for the screening, diagnosis, and treatment of diabetes in older adults
  • Provides recommendations for older patients with diabetes and macro and microvascular co-morbidities
  • Emphasizes shared-decision making and lesser targets/goals depending on health condition

Systematic Reviews


Essential 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. 

List of Recommendations

+ 1.0 Role of the Endocrinologist and Diabetes Care Specialist

+ 2.0 Screening for Diabetes and Prediabetes, and Diabetes Prevention

+ 3.0 Assessment of Older Patients with Diabetes

+ 4.0 Treatment of Hyperglycemia

+ 5.0 Treating Complications of Diabetes

+ 6.0 Special Settings and Populations