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Practice Guideline
. 2019 May 1;104(5):1520-1574.
doi: 10.1210/jc.2019-00198.

Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline

Derek LeRoith  1 , Geert Jan Biessels  2 , Susan S Braithwaite  3   4 , Felipe F Casanueva  5 , Boris Draznin  6 , Jeffrey B Halter  7   8 , Irl B Hirsch  9 , Marie E McDonnell  10 , Mark E Molitch  11 , M Hassan Murad  12 , Alan J Sinclair  13
Affiliations
Practice Guideline

Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline

Derek LeRoith et al. J Clin Endocrinol Metab. .

Abstract

Objective: The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults.

Conclusions: Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging effects interact with diabetes to accelerate the progression of many common diabetes complications. Each section in this guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.

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Conflict of interest statement

See Appendix C.

Disclaimer: The Endocrine Society’s clinical practice guidelines are developed to be of assistance to endocrinologists by providing guidance and recommendations for particular areas of practice. The guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgement of healthcare providers and each patient’s individual circumstances. The Endocrine Society makes no warranty, express or implied, regarding the guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein.

Figures

Figure 1.
Figure 1.
Duration of diabetes among adults aged ≥60 y, by age, United States, 2009–2010 (3). [Reproduced from Laiteerapong N, Huang ES. Chapter 16: Diabetes in older adults. In Cowie CC, Casagrande SS, Menke A, et al., eds. Diabetes in America, 3rd ed. Bethesda, MD: National Institutes of Health, NIH Pub No. 17-1468, 2017; pp 16-1 to 16-26.]
Figure 2.
Figure 2.
Cardiovascular complications among adults age ≥65 y, by diabetes status, United States, 2007–2010. Data are self-reported. Error bards represent 95% CIs. [Reproduced from Laiteerapong N, Huang ES. Chapter 16: Diabetes in older adults. In Cowie CC, Casagrande SS, Menke A, et al., eds. Diabetes in America, 3rd ed. Bethesda, MD: National Institutes of Health, NIH Pub No. 17-1468, 2017; pp 16-1 to 16-26.]
Figure 3.
Figure 3.
Microvascular complications among adults age ≥65 y, by diabetes status, United States, 2005–2010. Diabetes status is self-reported. Error bars represent 95% CIs. *Retinopathy detected by nonmydriatic digital fundus photography. Based on 2005–2008 data. †Microalbuminuria defined as an albumin-to-creatinine ratio of 30 to 300 mg/g. Based on 2007–2010 data. ‡Decreased kidney function based on eGFR <60 mL/min/1.73 m2 determined using the CKD-EPI equation and serum creatinine. 1Estimate is too unreliable to present; one case (or no cases) or relative SE >50%. [Reproduced from Laiteerapong N, Huang ES. Chapter 16: Diabetes in older adults. In Cowie CC, Casagrande SS, Menke A, et al., eds. Diabetes in America, 3rd ed. Bethesda, MD: National Institutes of Health, NIH Pub No. 17-1468, 2017; pp 16-1 to 16-26.]
Figure 4.
Figure 4.
Incidence (per 1000) of major diabetes complications according to age among adults with diabetes, 2009 (6). ER, emergency room; ESRD, end-stage renal disease; IHD, ischemic heart disease. [Reproduced from the National Diabetes Surveillance System at http://www.cdc.gov/diabetes]
Figure 5.
Figure 5.
Model for age-related hyperglycemia (9). [Adapted with permission from Chang AM, Halter JB. Aging and insulin secretion. Am J Physiol Endocrinol Metab 2003;284:E7–E12.]
See this image and copyright information in PMC

Comment in

  • Detecting sarcopenia in the older diabetic adults.
    Bahat G, Erdogan T, Cruz-Jentoft AJ. Bahat G, et al. Aging Clin Exp Res. 2019 Aug;31(8):1181-1182. doi: 10.1007/s40520-019-01272-w. Epub 2019 Jul 18. Aging Clin Exp Res. 2019. PMID: 31321742 No abstract available.

References

    1. Laiteerapong N, Karter AJ, Liu JY, Moffet HH, Sudore R, Schillinger D, John PM, Huang ES. Correlates of quality of life in older adults with diabetes: the diabetes & aging study. Diabetes Care. 2011;34(8):1749–1753. - PMC - PubMed
    1. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA. 2015;314(10):1021–1029. - PubMed
    1. Laiteerapong N, Huang ES. Diabetes in older adults. In: Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, Gregg EW, Knowler WC, Barrett-Connor E, Becker DJ, Brancati FL, Boyko EJ, Herman WH, Howard BV, Narayan KMV, Rewers M, Fradkin JE, eds. Diabetes in America. 3rd ed. Bethesda, MD: National Institutes of Health; 2018:16-1–16-26.
    1. Narayan KM, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ. Impact of recent increase in incidence on future diabetes burden: U.S., 2005–2050. Diabetes Care. 2006;29(9):2114–2116. - PubMed
    1. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, Huang ES, Korytkowski MT, Munshi MN, Odegard PS, Pratley RE, Swift CS; Consensus Development Conference on Diabetes and Older Adults . Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342–2356. - PMC - PubMed

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