Older Adults with Diabetes

2016 ADA Guideline Recommendations
Types of Diabetes Mellitus
Main Diabetes Page
Diabetes type I
Diabetes type II
Gestational Diabetes Mellitus
2016 ADA Standard of Medical Care Guideline Recommendations
Strategies for Improving Care
Classification and Diagnosis of Diabetes
Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Prevention or Delay of Type II Diabetes
Glycemic Targets
Obesity Management for Treatment of Type II Diabetes
Approaches to Glycemic Treatment
Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Tarek Nafee, M.D. [3]

2016 ADA Standards of Medical Care in Diabetes Guidelines

"1. Consider the assessment of medical, functional, mental, and social geriatric domains for diabetes management in older adults to provide a framework to determine targets and therapeutic approaches. (Level of Evidence: E)"

"2. Screening for geriatric syndromes may be appropriate in older adults experi- encing limitations in their basic and instrumental activities of daily living, as they may affect diabetes self-management. (Level of Evidence: E)"

"3. Older adults (≥65 years of age) with diabetes should be considered a high- priority population for depression screening and treatment. (Level of Evidence: B)"

"4.Hypoglycemia should be avoided in older adults with diabetes. It should be screened for and managed by adjusting glycemic targets and pharmacological interventions. (Level of Evidence: B)"

"5. Older adults who are functional and cognitively intact and have significant life expectancy may receive diabetes care with goals similar to those developed for younger adults. (Level of Evidence: E)"

"6. Glycemic goals for some older adults might reasonably be relaxed, using indi- vidual criteria, but hyperglycemia leading to symptoms or risk of acute hyper- glycemic complications should be avoided in all patients (Level of Evidence: E)"

"7. Screening for diabetes complications should be individualized in older adults, but particular attention should be paid to complications that would lead to functional impairment. (Level of Evidence: E)"

"8. Other cardiovascular risk factors should be treated in older adults with con- sideration of the time frame of benefit and the individual patient. Treatment of hypertension is indicated in virtually all older adults, and lipid-lowering and aspirin therapy may benefit those with life expectancy at least equal to the time frame of primary or secondary prevention trials. (Level of Evidence: E)"

"9. When palliative care is needed in older adults with diabetes, strict blood pressure control may not be necessary, and withdrawal of therapy may be appropriate. Similarly, the intensity of lipid management can be relaxed, and withdrawal of lipid-lowering therapy may be appropriate. (Level of Evidence: E)"

"10. Consider diabetes education for the staff of long-term care facilities to improve the management of older adults with diabetes (Level of Evidence: E)"

"11. Patients with diabetes residing in long-term care facilities need careful assess- ment to establish a glycemic goal and to make appropriate choices of glucose- lowering agents based on their clinical and functional status. (Level of Evidence: E)"

"12. Overall comfort, prevention of distressing symptoms, and preservation of quality of life and dignity are primary goals for diabetes management at the end of life. (Level of Evidence: E)"