12. Older Adults:Standards of Medical Care in Diabetes—2021

Abstract

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the 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 (https://doi.org/10.2337/dc21-SPPC), 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 (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus

“…Antiglycemic overtreatment of older patients with T2DM has been shown to be common and the possibly resulting harm is cited in guidelines. 31 34 35 In our study, 2.8% and 2.4% of the patients were documented with severe hypoglycemia and the event rates per 100 PY were low (HI/NPH 4.40 vs BIA 4.07) and even lower for hypoglycemia with coma (HI/NPH 3.26 vs BIA 3.64), tending toward lower rates with BIA, but without significant differences. There is no clear evidence of studies comparing the two insulin types with regard to the risk of hypoglycemic events.…”

“…Antiglycemic overtreatment of older patients with T2DM has been shown to be common and the possibly resulting harm is cited in guidelines. 31 34 35 …”

Special Considerations in the Management and Education of Older Persons With Diabetes

“…Individual and disease factors including disease duration, life expectancy, comorbid conditions, hypoglycemia risk, attitudes, resources, and support systems are critical areas of consideration to determine optimal blood glucose targets. 3,15,16 Consideration of individual and caregiver preferences is an important aspect of personcentered treatment, with recognition that reassessment is ongoing because health status and preferences may change over time. 9 See Consideration for use of a professional or personal continuous glucose monitor is as-sessed based on the person's ability, clinical status, financial status, and preference.…”

“…2 Older adults can present with coexisting conditions, including cardiovascular disease; hearing, visual, and cognitive impairment; increased urinary incontinence; falls; and polypharmacy considerations, which directly impact clinical management and diabetes education approaches. 3 This paper provides a framework that the Diabetes Care and Education Specialist (DCES) can utilize to care for older adults. It aims to equip key stakeholders with an understanding of the scope of work and role that a DCES has on the integrated care team.…”

“…ADL, activities of daily. Reprinted with permission from American Diabetes Association Standards of Medical Care 2021, Standard 12, Older Adults, page S174 3. n Devise an education plan.n Advocate for simplified plans.n n Determine financial barriers.…”