Diabetes Management in Older Adults

 

OVERVIEW

Diabetes is one of the world’s leading public health concerns that significantly affect quality of life and contribute to increased morbidity, mortality, and healthcare costs. Older adults are disproportionately affected by diabetes. Diabetes management among older adults is complex and complicated by factors such as the presence of comorbidities, variations in the clinical presentations of the comorbidities, and functional and cognitive impairments. It is, therefore, important that clinicians are conversant with the clinical guidelines for diabetes management in older adults.

 

BACKGROUND/STATEMENT OF PROBLEM

A. Diabetes is defined as a group of metabolic conditions characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both (ElSayed et al., 2023a, 2023b).

B. The main types of diabetes are:

  1. Type 1 diabetes: T1D is caused by autoimmune destruction of the pancreatic beta-cells, resulting in insulin deficiency.
  2. Type 2 diabetes: T2D results from gradual, nonautoimmune loss of beta-cell insulin production, mostly resulting from insulin resistance and metabolic syndrome. T2D accounts for 90% to 95% of all diabetes.

C. Risk factors for diabetes in older adults include:

  1. Aging
  2. Obesity
  3. Sarcopenia
  4. Insulin resistance
  5. Skeletal muscle dysfunction
  6. Central obesity
  7. Frailty
  8. Chronic inflammation
  9. Central adiposity
  10. Beta-cell dysfunction
  11. Malnutrition
  12. Hyperglucagonemia
  13. Physical inactivity
  14. Impaired incretin response
  15. Neuromuscular dysfunction
  16. Hyperglycemia
  17. Beta-cell dysfunction
  18. Hyperlipidemia
  19. Hormonal dysregulation and/or deficiency (growth and sex hormones; Bellary et al., 2021)

D. For diagnosis of diabetes, see Table 23.1.

E. Treatment of diabetes in older adults includes the following:

  1. Glycemic targets should be individualized to prevent hypoglycemia.
  2. Nonpharmacological management (behavior modification): Perform a nutritional assessment to promote healthy eating. Plan adequate and regular physical activity.
  3. Pharmacological management (see Table 23.2): Medications should be tailored based on the individual’s characteristics, needs, and preferences.

PARAMETERS OF ASSESSMENT

See text on:

A. Cognitive assessment

B. Glycemic variability and hypoglycemia

C. Functional status

D. Behavioral/lifestyle management

NURSING CARE STRATEGIES

A. Physical, emotional, psychological, and social needs should all be considered when providing nursing care for older adults with diabetes.

B. Nurses caring for older adults with diabetes should perform a thorough assessment to evaluate the presence of geriatric syndromes such as dementia, frailty, disability, falls, pain, depression, polypharmacy, and incontinence.

C. Nurses can provide diabetes education and ensure all older adults with diabetes receive DSMES from a diabetes care and education specialist.

D. Individuals who present with new-onset complications should be referred for appropriate intervention.

E. Early intervention by multidisciplinary teams can help reduce the risk of worsening symptoms. Institutions should have a diabetes care and education specialist to provide the needed education and support for older adults living with diabetes.

F. Institutions should implement culturally appropriate strategies for supporting older adults with diabetes.

EVALUATION AND EXPECTED OUTCOMES

A. Reduction of diabetes complications through referrals to specialists, use of appropriate assessment, and management strategies.

B. Older adults and caregivers would know the appropriate diabetes interventions for hypoglycemia, blood glucose monitoring, and so on.

C. Older adults should be periodically assessed for cognitive decline, hypoglycemia, and polypharmacy.

D. Institutional establishment of clear and evidence-based guidelines for the management of diabetes in older adults.

FOLLOW-UP MONITORING OF CONDITION

A. Older adults should be seen by their primary care providers for follow-up monitoring of glycemic levels, cholesterol, blood pressure, and cognitive function.

RELEVANT PRACTICE GUIDELINES AND RESOURCES

A. Elsayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C., & Gabbay, R. A. (2023). 13. Older adults: Standards of care in diabetes—2023. Diabetes Care, 46(Supplement_1), S216–S229. https://doi.org/10.2337/DC23-S013

B. LeRoith, D., Biessels, G. J., Braithwaite, S. S., Casanueva, F. F., Draznin, B., Halter, J. B., Hirsch, I. B., McDonnell, M. E., Molitch, M. E., & Murad, M. H. (2019). Treatment of diabetes in older adults: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1520–1574.

C. Leung, E., Wongrakpanich, S., & Munshi, M. N. (2018). Diabetes management in the elderly. Diabetes Spectrum: A Publication of the American Diabetes Association, 31(3), 245.

ABBREVIATIONS

DSMES       diabetes self-management education and support

T1D            type 1 diabetes

T2D            type 2 diabetes

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Updated: January 2025

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti, PhD, RN, FAAN, E.A., & Fulmer PhD, RN, FAAN, T. T. (2025). Evidence-Based Geriatric Nursing Protocols for Best Practice (7th ed.). Springer Publishing. Retrieved December 17, 2024, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826152763.html#tableofcontents

Chapter 23, Boakye, M.D.S., Owolabi, E.O., Omololu, S.O., Whitehouse, C.R. & Allen, N.A. (2025) Care and Management of Diabetes in Older Adults

 

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