1.0.0.0 Older Adults

The Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) “Stan­dards of Med­i­cal Care in Di­a­betes” in­cludes ADA’s cur­rent clin­i­cal prac­tice rec­om­men­da­tions and is in­tend­ed to pro­vide the com­po­nents of di­a­betes care, gen­er­al treat­ment goals and guide­lines, and tools to eval­u­ate qual­i­ty of care. Mem­bers of the ADA Pro­fes­sion­al Prac­tice Com­mit­tee, a mul­ti­dis­ci­plinary ex­pert com­mit­tee, are re­spon­si­ble for up­dat­ing the Stan­dards of Care an­nu­al­ly, or more fre­quent­ly as war­rant­ed. For a de­tailed de­scrip­tion of ADA stan­dards, state­ments, and re­ports, as well as the ev­i­dence-‍grad­ing sys­tem for ADA’s clin­i­cal prac­tice rec­om­men­da­tions, please refer to the Stan­dards of Care In­tro­duc­tion. Read­ers who wish to com­ment on the Stan­dards of Care are in­vit­ed to do so at pro­fes­sion­al.di­a­betes.org/‍SOC.

Di­a­betes is an im­por­tant health con­di­tion for the aging pop­u­la­tion; ap­prox­i­mate­ly one-‍quar­ter of peo­ple over the age of 65 years have di­a­betes and one-‍half of older adults have predi­a­betes (1), and this pro­por­tion is ex­pect­ed to in­crease rapid­ly in the com­ing decades. Older in­di­vid­u­als with di­a­betes have high­er rates of pre­ma­ture death, func­tion­al dis­abil­i­ty, ac­cel­er­at­ed mus­cle loss, and co­ex­ist­ing ill­ness­es, such as hy­per­ten­sion, coro­nary heart dis­ease, and stroke, than those with­out di­a­betes. Older adults with di­a­betes also are at greater risk than other older adults for sev­er­al com­mon geri­atric syn­dromes, such as polyphar­ma­cy, cog­ni­tive im­pair­ment, uri­nary in­con­ti­nence, in­ju­ri­ous falls, and per­sis­tent pain. These con­di­tions may im­pact older adults’ di­a­betes self-‍man­age­ment abil­i­ties (2). See Sec­tion 4 “Com­pre­hen­sive Med­i­cal Eval­u­a­tion and As­sess­ment of Co­mor­bidi­ties” for co­mor­bidi­ties to con­sid­er when car­ing for older adult pa­tients with di­a­betes.

Screen­ing for di­a­betes com­pli­ca­tions in older adults should be in­di­vid­u­al­ized and pe­ri­od­i­cal­ly re­vis­it­ed, as the re­sults of screen­ing tests may im­pact ther­a­peu­tic ap­proach­es and tar­gets (2-4). Older adults are at in­creased risk for de­pres­sion and should there­fore be screened and treat­ed ac­cord­ing­ly (5). Di­a­betes man­age­ment may re­quire as­sess­ment of med­i­cal, psy­cho­log­i­cal, func­tion­al, and so­cial do­mains. This may pro­vide a frame­work to de­ter­mine tar­gets and ther­a­peu­tic ap­proach­es, in­clud­ing whether re­fer­ral for di­a­betes self-‍man­age­ment ed­u­ca­tion is ap­pro­pri­ate (when com­pli­cat­ing fac­tors arise or when tran­si­ti­ons in care occur) or whether the cur­rent reg­i­men is too com­plex for the pa­tient’s self-‍man­age­ment abil­i­ty. Par­tic­u­lar at­ten­tion should be paid to com­pli­ca­tions that can de­vel­op over short pe­ri­ods of time and/‍or would significant­ly im­pair func­tion­al sta­tus, such as vi­su­al and lower-‍ex­trem­i­ty com­pli­ca­tions. Please refer to the Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) con­sen­sus re­port “Di­a­betes in Older Adults” for de­tails (2).