Sec­tion 13. Old­er Adults

(https:/​/​doi.org/​10.2337/​dc23-​S013)

The lan­guage in Rec­om­men­da­tion 13.5 was strength­ened for old­er adults with type 1 di­a­betes to rec­om­mend con­tin­u­ous glu­cose mon­i­tor­ing to re­duce hy­po­glycemia with an ev­i­dence grade of A based on a 6-​month ex­ten­sion of the Wire­less In­no­va­tion in Se­niors with Di­a­betes Mel­li­tus (WIS­DM) tri­al and ob­ser­va­tion­al data from the Di­a­betes Con­trol and Com­pli­ca­tions Tri­al/​Epi­demi­ol­o­gy of Di­a­betes In­ter­ven­tions and Com­pli­ca­tions (DCCT/​EDIC) study.

Rec­om­men­da­tion 13.6 was added to com­mu­ni­cate that for old­er adults with type 2 di­a­betes on mul­ti­ple dai­ly dos­es of in­sulin, con­tin­u­ous glu­cose mon­i­tor­ing should be con­sid­ered to im­prove glycemic out­comes and de­crease glu­cose vari­abil­i­ty, with an ev­i­dence grade of B based on re­sults of the DI­A­MOND (Mul­ti­ple Dai­ly In­jec­tions and Con­tin­u­ous Glu­cose Mon­i­tor­ing in Di­a­betes) tri­al.

A new Rec­om­men­da­tion 13.7 was added: for old­er adults with type 1 di­a­betes, con­sid­er the use of au­to­mat­ed in­sulin de­liv­ery sys­tems (ev­i­dence grade B) and oth­er ad­vanced in­sulin de­liv­ery de­vices such as con­nect­ed pens (ev­i­dence grade E) should be con­sid­ered to re­duce risk of hy­po­glycemia, based on in­di­vid­u­al abil­i­ty. The ad­di­tion of this rec­om­men­da­tion was based on the re­sults of two small ran­dom­ized con­trolled tri­als (RCTs) in old­er adults, which demon­strat­ed that hy­brid closed-​loop ad­vanced in­sulin de­liv­ery im­proved glu­cose met­rics rel­a­tive to sen­sor-​aug­ment­ed pump ther­a­py.

Blood pres­sure treat­ment goals in Table 13.1 were low­ered to align with ev­i­dence from mul­ti­ple re­cent tri­als.

Rec­om­men­da­tion 13.15 was split into two rec­om­men­da­tions (now 13.17 and 13.18) to ac­knowl­edge the con­cep­tu­al dif­fer­ences be­tween dein­ten­sification of goals (13.17) and sim­plification of com­plex reg­i­mens (13.18).

In rec­om­men­da­tion 13.17, dein­ten­sification of treat­ment goals is now rec­om­mend­ed to re­duce the risk of hy­po­glycemia if it can be achieved with­in the in­di­vid­u­al­ized A1C tar­get.

In a new rec­om­men­da­tion 13.18, sim­plification of com­plex treat­ment plans (es­pe­cial­ly in­sulin) is now rec­om­mend­ed to re­duce the risk of hy­po­glycemia and polyphar­ma­cy and de­crease the bur­den of the dis­ease if it can be achieved with­in the in­di­vid­u­al­ized A1C tar­get.

Rec­om­men­da­tion 13.22 was added to con­sid­er use of CGM to as­sess risk for hy­po­glycemia in old­er adults treat­ed with sul­fony­lureas or in­sulin, de­spite the lack of ev­i­dence.