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Caring for an Older Person with Diabetes Mellitus

Diabetes mellitus (DM) is very common among persons age 65 and older, particularly among racial and ethnic minorities, and it is on the rise. Although there are many evidence-based guidelines for DM, few are specifically targeted toward the needs of older persons, so few can help clinicians prioritize care for the older adults they may see in their practices.

There are several unique elements of these guidelines. First, throughout the guidelines, an individualized approach to care is emphasized. Older adults with DM are a heterogeneous population, ranging from those who are otherwise very healthy with excellent functional status to those who have several other chronic conditions and significant functional impairment. Assessing a patient's functional status, rather than relying simply on age, is critical to providing appropriate care.

These guidelines emphasize the development of individualized goals and treatment plans and pay special attention to the potential impact of treatment decisions on both immediate and long-term quality of life. Particularly for older persons with diabetes, the benefits gained from treating hypertension and dyslipidemias are potentially great since heart attacks and strokes are the leading causes of disability and death in this group.

There are also important benefits associated with control of blood sugar. These include the immediate benefits of symptom reduction and the longer term benefits of fewer diabetes-related complications, such as blindness and kidney disease.