Image of older adult testing himself for diabetes.
Patient Resources

Diabetes and Older Adults

January 23, 2022

As the general population continues to age, the number of adults 65 years or older affected by diabetes is also increasing. An estimated 33% of adults aged 65 or older have diabetes. This population is more at risk of developing diabetes-related complications like hypoglycemia (low blood sugar), kidney failure, and heart disease than younger people living with diabetes. 

There is new and emerging information to improve the understanding and treatment for diabetes in older adults. Special considerations should be addressed to support overall health and quality of life. Older adults often have one or more co-existing conditions like cognitive impairment, cardiovascular disease, and others that impact diabetes education and management. 

The relevant therapies for glycemic control, hyperlipidemia, and hypertension are important in older people.

Estimated Glomerular Filtration Rate (eGFR) - A test to measure the level of kidney function and determine the stage of kidney disease. 

Functional status- A person's ability to perform normal daily activities required to meet basic needs, fulfill usual roles, and maintain health and well-being. 

Geriatric syndromes- A group of risk factors like cognitive impairment, functional status, and mobility impairment that may occur in older people, especially those with diabetes. 

Macrovascular complications- Complication related to diabetes that affect large blood vessels such as heart disease, or stroke. 

Microvascular complications- Complications related to diabetes that affect small blood vessels such as eye problems or kidney disease. 

Older adult- Age 65 years or older. 

Sarcopenia- Loss of muscle tissue, function, and strength which can occur with aging, diabetes, and other coexisting health problems. 

Hypoglycemia – glucose is less than 70 mg per deciliter 

The treatment of diabetes in adults 65 years and older should be based on an assessment of your overall health and other medical conditions. Medication regimens should be simplified in adults 65 years to improve adherence and prevent treatment-related complications. Glycemic targets should be a shared decision between you and your healthcare team and tailored to each individual.

General Health Assessments: 

  • Functional Status (ADLs/IADLs) 
  • Mental Health Screening 
  • Screening for cognitive impairment and dementia 
  • Frailty & Physical Exam 
  • Body Mass Index (BMI) 
  • Lifestyle Assessment 
  • Medication Review 
  • Cancer Screening 
  • Hearing Test 

General Health Tests: 

  • Electrocardiogram (EKG)- used to evaluate the condition of your heart 
  • Lipid Panel- measures the amount of cholesterol and fats in the blood 
  • Bone Mineral Density 
  • Abdominal Aortic Aneurysm (AAA) Ultrasound- an abdominal screening to help check for kidney stones, liver disease, tumors, and many other conditions 
  • Hemoglobin A1C test, oral glucose tolerance test and fasting blood glucose test are used diagnose diabetes or prediabetes. These tests estimate your average blood glucose level over a 3-month period.

Diabetes- Specific Assessments: 

  • Eye Exam (Retinopathy) 
  • Kidney Screening (Nephropathy) 
  • Nerve Damage (Neuropathy) 
  • Medical Nutrition Therapy 
  • Diabetes Self-Management and Training 

The most important factors are heredity and overweight and sedentary lifestyle in elderly patients. The symptoms of patients with diabetes are highly variable, they can be asymptomatic for a long time, that is why annual screening is important and acute symptoms such as blurred vision, weight loss, thirst, hunger, increased urinary frequency should go to your center of health. 

There are many ways to reduce the risk of diabetes complications, including: keeping your blood sugar and hemoglobin A1C within recommended range, keeping your blood pressure and cholesterol under control, staying active by exercising, eating a healthy diet, avoiding alcohol and cigarette smoking. 

It is important to follow your doctor’s recommendations including seeing an eye specialist and getting your kidney function checked every year. Your healthcare team can help you establish personal goals for diabetes management.  

Common complications of diabetes affecting adults aged 65 and older are: 

  • Kidney disease including kidney failure 
  • Loss of vision 
  • Heart disease 
  • Stroke 
  • Peripheral vascular disease (PVD) – narrowed blood vessels 
  • Peripheral neuropathy (nerve damage 
  • Low blood sugar (hypoglycemia) 

Older adults who are otherwise healthy with few coexisting chronic illnesses and intact cognitive function and functional status should have lower glycemic goals (such as A1C <7.0–7.5% [53–58 mmol/mol]), while those with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence should have less stringent glycemic goals (such as A1C <8.0–8.5% [64–69 mmol/mol.  

Collaborative care is very important for all people living with diabetes. However, it is extremely critical for some older adults who have complex health care needs, they live with polypharmacy. Some important care considerations include: 

  • Supporting “at home” needs 
  • Monitoring interactions between medications 
  • Preventing falls 
  • Family or community support 
  • Access to proper medications and food 

Your primary care doctor, geriatrician, diabetes educator, endocrinologist, nutritionist, and social worker work together to make sure all aspects of care are carefully developed to achieve personal goals and to prevent short and long-term complications. 

Older adults should consider lifestyle changes such as exercise, nutrition, managing blood sugar, limiting alcohol, and avoiding smoking. Progression from prediabetes to diabetes can be slowed with a diabetes prevention program. 

A healthcare provider will assess your overall health and develop the best care plan based on personal goals, functional status, geriatric syndromes, sarcopenia, and other chronic illnesses. Care plans are customized and different for each person. A diabetes prevention program is recommended for people with prediabetes to prevent progression to diabetes. 

If you have hyperglycemia (high blood sugar), chronic kidney disease (CKD), or cardiovascular disease (CVD) your doctor may adjust your diabetes medication dosage based on your estimated glomerular filtration rate (eGFR) level to help reach glycemic targets and minimize complications. This chart can be used to help you have a more informed conversation with your healthcare provider about your medication dosage. 

Diabetes management goals will not be the same for everyone and may change over time. It is important to talk honestly with your healthcare team to have the best outcomes and prevent complications. Questions to ask your doctor may include: 

  • What is my target goal for managing blood glucose and hemoglobin A1c? 
  • How can I prevent diabetes complications? 
  • How can I prevent low blood sugar? 
  • How often should I see an endocrinologist and other specialists? 

Image of patient guide on special considerations for older adults with diabetes.

Developed for patients based on Treatment of Diabetes in Older Adults, An Endocrine Society Clinical Practice Guideline.

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