Treating Older Adults With Diabetes: An Endocrine Society Guideline

The Endocrine Society has released new guidelines for clinicians treating older adults with diabetes, which have been published in The Journal of Clinical Endocrinology & Metabolism.

To establish the guidelines, 2 systematic reviews were performed. The first review focused on whether treatment with antihypertensive pharmacologic therapy led to improvement in patient-reported outcomes in older adults and included 19 randomized trials. The second review focused on whether treatment with lipid-lowering pharmacologic therapy led to improvement in patient-reported outcomes in older adults. This review included 23 randomized trials.

The Endocrine Society presented the following guidelines for treating older adults (≥65 years) with diabetes.

Guidelines for the role of endocrinologists and diabetes care specialists

·   For patients aged ≥65 years with newly diagnosed diabetes, endocrinologists or diabetes care specialists should work with a primary care provider, a multidisciplinary team, and the patient to develop diabetes treatment goals tailored to the patient.

·   If a patient aged ≥65 years has type 1 diabetes, requires complex hyperglycemia treatment, has recurrent severe hypoglycemia, or has multiple diabetes complications, an endocrinologist or diabetes care specialist should be primarily responsible for the patient’s diabetes care.

Guidelines for diabetes screening and prevention

·   Fasting plasma glucose and/or hemoglobin A1c (HbA1c) screening should be used to diagnose diabetes or prediabetes in patients aged ≥65 without known diabetes.

·   If a patient meets the criteria for prediabetes by fasting glucose or HbA1c, a 2-hour glucose postoral glucose tolerance test measurement should be obtained.

·   Patients aged ≥65 years who have prediabetes should adhere to a lifestyle program such as the Diabetes Prevention Program to delay the progression to diabetes.

Guidelines for assessing older patients with diabetes

·   Before determining treatment goals and strategies, assess the patient’s overall health and personal values.

·   Periodic cognitive screening should be performed to identify undiagnosed cognitive impairment.

·   If a patient has a diagnosis of diabetes and cognitive impairment, medication regimens should be simplified and glycemic targets should be tailored to improve compliance and prevent treatment-related complications.

Guidelines for treating hyperglycemia

·   Outpatient diabetes regimens should be designed to minimize hyperglycemia.

·   For patients treated with insulin, frequent fingerstick glucose monitoring and/or continuous glucose monitoring is recommended.

Guidelines for lifestyle interventions

·   For ambulatory patients, lifestyle modification should be the first-line treatment of hyperglycemia.

·   Assess patients’ nutrition to detect and manage malnutrition.

·   For patients with frailty, diets high in protein and energy are recommended to prevent malnutrition and weight loss.

·   For patients who cannot achieve glycemic targets through lifestyle modification, avoid the use of restrictive diets. Instead, focus on limiting the consumption of simple sugars if the patient is at risk for malnutrition.