Diabetes Management in Older Adults

Diabetes in older adults presents a complex interplay of physiological ageing, multimorbidity and functional decline. Age‐related changes in renal and hepatic clearance, alterations in body composition and increased susceptibility to hypoglycaemia necessitate individualised glycaemic targets, often less stringent than in younger populations. Comprehensive assessment of cognitive function, frailty, nutritional status and risk of falls underpins safe pharmacotherapy and lifestyle interventions. Metformin remains first‐line where tolerated, with dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists favoured for their low hypoglycaemia risk and cardiovascular benefits. Insulin regimens are simplified to minimise dosing errors and adverse events. Non‐pharmacological strategies, including tailored dietary plans, resistance and balance training, and structured self‐management education, are essential to preserve autonomy and quality of life. Coordination between geriatricians, endocrinologists, nurses and allied health professionals optimises medication review, addresses polypharmacy and embeds patient‐centred goals. Technological advances such as continuous glucose monitoring systems are increasingly adapted for older cohorts to refine treatment decisions, while telehealth platforms support remote monitoring and education. Globally, harmonising clinical guidelines with local resource availability remains a priority to ensure equitable, evidence‐based care for the growing elderly diabetic population.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Diabetes Management in Older Adults publication trend

The graph below shows the total number of articles in diabetes management in older adults across all publications each year (not limited to Nature Index journals).

Technical terms

HbA1c: Glycated haemoglobin reflecting average blood glucose over two to three months.

Frailty: A clinical syndrome characterised by decreased physiological reserve and increased vulnerability to stressors.

Short Physical Performance Battery (SPPB): A composite test of balance, gait speed and lower-limb strength used to assess physical function.

Polypharmacy: The concurrent use of multiple medications, raising the risk of drug interactions and adverse events.

References

1. Physical performance strongly predicts all-cause mortality risk in a real-world population of older diabetic patients: machine learning approach for mortality risk stratification. Frontiers in Endocrinology (2024).
2. Assessment of Barriers to Improve Diabetes Management in Older Adults A randomized controlled study. Diabetes Care (2013).
3. Should dietary restrictions be imposed on Alzheimer’s Disease patients affected by type 2 diabetes?. Dialogues in Clinical Neuroscience (2024).