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The comprehensive assessment de-\nscribed above provides a framework to de-termine goals and therapeutic approaches\n(8–10), including whether referral for dia-\nbetes self-management education is ap- | [
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betes self-management education is ap-\npropriate (when complicating factors ariseor when transitions in care occur) orwhether the current plan is too complexfor the individual ’s self-management ability\nor the caregivers providing care (11). Par-ticular attention should be paid to com-\nplications that can develop ov... | [
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plications that can develop over short\nperiods of time and/or would signi ficantly\nimpair functional status, such as visual andlower-extremity complications. Please referto the American Diabetes Association(ADA) consensus report “Diabetes in Older\nAdults ”for details (3).\nNEUROCOGNITIVE FUNCTION\nRecommendation\n13.... | [
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Recommendation\n13.3 Screening for early detection of\nmild cognitive impairment or demen-\nt i as h o u l db ep e r f o r m e df o ra d u l t s65 years of age or older at the initialvisit, annually, and as appropriate. B\nOlder adults with diabetes are at higher\nrisk of cognitive decline and institutionali- | [
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risk of cognitive decline and institutionali-\nzation (12,13). The presentation of cogni-tive impairment ranges from subtle\nexecutive dysfunction to memory loss | [
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executive dysfunction to memory loss\nand overt dementia. People with diabe-tes have higher incidences of all-causedementia, Alzheimer disease, and vascu-lar dementia than people with normalglucose tolerance (14). Poor glycemicmanagement is associated with a decline\nin cognitive function (15,16), and longer | [
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in cognitive function (15,16), and longer\nduration of diabetes is associated withworsening cognitive function. There areongoing studies evaluating whetherlifestyle interventions may help to main-tain cognitive function in older adults(17). However, studies examining the ef- | [
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fects of diabetes prevention or intensiveglycemic and blood pressure manage-ment to achieve speci fic goals have not\ndemonstrated a reduction in brain func-\ntion decline (18,19). In observational stud-\nies as well as post hoc analyses fromrandomized clinical trials, certain glucose-lowering drugs, such as metformin, ... | [
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zolidinediones, and glucagon-like peptide 1\n(GLP-1) receptor agonists have shownsmall bene fits on slowing progression of\ncognitive dysfunction (20). Cardiovascular\nrisk factors are also associated with an in-\ncreased risk of cognitive decline and de-mentia. Control of blood pressure andcholesterol lowering with sta... | [
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been associated with a reduced risk of inci-\ndent dementia and are, thus, particularlyimportant in older adults with diabetes.\nRecently, the U.S. Food and Drug Ad-\nministration (FDA) has approved two new\nanti-amyloid monoclonal antibodies for | [
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anti-amyloid monoclonal antibodies for\nthe treatment of early Alzheimer disease(21). These drugs lower the amyloid bur-den in the brain and appear to slow cog-\nnitive decline in the populations tested.\nWhether these drugs will be useful inother populations including older adultswith diabetes remains to be determined... | [
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Despite the paucity of therapies to\nprevent or remedy cognitive decline,identifying cognitive impairment early hasimportant implications for diabetes care.The presence of cognitive impairment canmake it challenging for clinicians to help\npeople with diabetes reach individualized | [
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people with diabetes reach individualized\nglycemic, blood pressure, and lipid goals.Cognitive dysfunction may make it diffi -\ncult for individuals to perform complex\nself-care tasks (22), such as monitoring\nglucose and adjusting insulin doses. It canalso hinder their ability to appropriatelymaintain the timing of me... | [
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of the diet. These factors increase risk for\nhypoglycemia, which, in turn, can worsencognitive function. When clinicians areproviding care for people with cognitive\ndysfunction, it is critical to simplify care\nplans and to facilitate and engage the ap-propriate support structure to assist indi-viduals in all aspects... | [
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Older adults with diabetes should be\ncarefully screened and monitored forcognitive impairment (2). Several simpleassessment tools are available to screenfor cognitive impairment (22,23), such asthe Mini-Mental State Examination (24),\nMini-Cog (25), and the Montreal Cogni- | [
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Mini-Cog (25), and the Montreal Cogni-\ntive Assessment (26), which may help toidentify individuals requiring neuropsy-\nchological evaluation, particularly when | [
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dementia is suspected (i.e., in thoseexperiencing memory loss, a decrease inexecutive function, and declines in theirbasic and instrumental activities of dailyliving). Annual screening is indicated foradults 65 years of age or older for earlydetection of mild cognitive impairmentor dementia (4,27). Screening for cogni-... | [
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dementia (4,27). Screening for cogni-tive impairment should additionally beconsidered when an individual presentswith a signifi cant decline in clinical status | [
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due to increased problems with self-careactivities and medication management,such as errors in calculating insulin dose,difficulty counting carbohydrates, skipped\nmeals, skipped insulin doses, and dif ficulty | [
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meals, skipped insulin doses, and dif ficulty\nrecognizing, preventing, or treating hypo-glycemia. People who screen positive forcognitive impairment should receive diag-nostic assessment as appropriate, includingreferral to a behavioral health professionalfor formal cognitive/neuropsychologicalevaluation (28).\nHYPOGLY... | [
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HYPOGLYCEMIA\nRecommendations\n13.4 Because older adults with dia-\nbetes have a greater risk of hypogly-\ncemia, especially when treated withhypoglycemic agents (e.g., sulfonylur-\neas, meglitinides, and insulin), than\nyounger adults, episodes of hypogly-\ncemia should be ascertained and ad-\ndressed at routine visit... | [
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cemia should be ascertained and ad-\ndressed at routine visits. B\n13.5 For older adults with type 1 dia-\nbetes, continuous glucose monitoringis recommended to reduce hypogly-\ncemia. A\n13.6 For older adults with type 2 dia-\nbetes on insulin therapy, continuousglucose monitoring should be consid-\nered to improve gl... | [
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ered to improve glycemic outcomes\nand reduce hypoglycemia. B\n13.7 For older adults with type 1 dia-\nbetes, consider the use of automatedinsulin delivery (AID) systems Aand\nother advanced insulin delivery devicessuch as connected pens Eto reduce\nrisk of hypoglycemia, based on indi-vidual ability and support system. | [
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Older adults are at higher risk of hypogly-\ncemia for many reasons, including\nerratic meal intake, insulin de ficiency ne-\ncessitating insulin therapy, and progres-sive renal insuf ficiency (29). As describeddiabetesjournals.org/care Older Adults S245\n©AmericanDiabetesAssociation | [
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above, older adults have higher rates of\nunidenti fied cognitive impairment and\ndementia, leading to dif ficulties in adher-\ning to complex self-care activities (e.g.,\nglucose monitoring and insulin dose ad-\njustment). Cognitive decline has beenassociated with increased risk of hypogly-\ncemia, and conversely, sever... | [
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cemia, and conversely, severe hypoglyce-\nmia has been linked to increased risk ofdementia (30 –32). Therefore, as dis-\ncussed in Recommendation 13.3, it is im-portant to routinely screen older adultsfor cognitive impairment and dementia\nand discuss findings with the individuals\nand their caregivers.\nPeople with dia... | [
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and their caregivers.\nPeople with diabetes and their care-\ngivers should be routinely queried abouthypoglycemia (e.g., selected questions\nf r o mt h eD i a b e t e sC a r eP r o fil e )( 3 3 )a n d\nimpaired hypoglycemia awareness as dis-\nc u s s e di nS e c t i o n6 ,“ Glycemic Goals and\nHypoglycemia.” Older adult... | [
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Hypoglycemia.” Older adults can also be\nstratified for future risk for hypoglycemia\nwith validated risk calculators (e.g., Kai-\nser Hypoglycemia Model) (34) and withconsideration of hypoglycemia risk fac-\ntors ( Table 6.5 ). An important step to\nmitigate hypoglycemia risk is to deter- | [
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mitigate hypoglycemia risk is to deter-\nmine whether the person with diabetesis skipping meals or inadvertently repeat-\ning doses of their medications. Glycemic\ngoals and pharmacologic treatments mayneed to be adjusted to minimize the oc-\ncurrence of hypoglycemic events (2). This | [
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currence of hypoglycemic events (2). This\nrecommendation is supported by resultsfrom multiple randomized controlled tri-\nals, such as the Action to Control Cardio-\nvascular Risk in Diabetes (ACCORD) studyand the Veterans Affairs Diabetes Trial\n(VADT), which showed that intensive | [
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(VADT), which showed that intensive\ntreatment protocols aimed to achievean A1C <6.0% with complex drug plans\nsignifi cantly increased the risk for hypo-\nglycemia requiring assistance comparedwith standard treatment (35,36). How-ever, these intensive treatment plans in-\ncluded extensive use of insulin and | [
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cluded extensive use of insulin and\nminimal use of GLP-1 receptor agonists,and they preceded the availability of\nsodium –glucose cotransporter 2 (SGLT2)\ninhibitors.\nUse of Continuous Glucose\nMonitoring and Advanced Insulin\nDelivery Devices\nFor older adults with type 1 diabetes, | [
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Delivery Devices\nFor older adults with type 1 diabetes,\ncontinuous glucose monitoring (CGM) isa useful approach to predicting and re-\nducing the risk of hypoglycemia (37). In\nthe Wireless Innovation in Seniors withDiabetes Mellitus (WISDM) trial, adults | [
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over 60 years of age with type 1 diabe-tes were randomized to CGM or stan-dard blood glucose monitoring. Over6 months, use of CGM resulted in a small\nbut statistically signifi cant reduction in time\nspent with hypoglycemia (glucose level\n<70 mg/dL) compared with standard blood\nglucose monitoring (adjusted treatment ... | [
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glucose monitoring (adjusted treatment dif-\nference /C01.9% [ /C027 min/day]; 95% CI\n/C02.8% to /C01.1% [/C040 to/C016 min/day];\nP<0.001) (38,39). Among secondary out-\ncomes, time spent in range between 70and 180 mg/dL increased by 8% (95% CI\n6.0–11.5) and glycemic variability (%CV) de- | [
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6.0–11.5) and glycemic variability (%CV) de-\ncreased. A 6-month extension of the trialdemonstrated that these bene fits were sus-\ntained for up to a year (40). These and\nother short-term trials are supported by ob-\nservational data from the Diabetes Controland Complications Trial/Epidemiology ofDiabetes Intervention... | [
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tions (DCCT/EDIC) study indicating that\namong older adults (mean age 58 years)with long-standing type 1 diabetes, rou-tine CGM and insulin pump use was as-\nsociated with fewer hypoglycemic events | [
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sociated with fewer hypoglycemic events\nand hyperglycemic excursions and lowerA1C levels (41). While the current evi-dence base for older adults is primarilyin type 1 diabetes, the evidence demon-\nstrating the clinical bene fits of CGM for\npeople with type 2 diabetes using insulin\nis growing (42) (see Section 7, “Di... | [
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is growing (42) (see Section 7, “Diabetes\nTechnology ”). The DIAMOND (Multiple\nDaily Injections and Continuous GlucoseMonitoring in Diabetes) study demon-strated that in adults $60 years of age\nwith either type 1 or type 2 diabetes us-\ning multiple daily injections, CGM use | [
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ing multiple daily injections, CGM use\nwas associated with improved A1C andreduced glycemic variability (43). Olderadults with physical or cognitive limita-tions who require monitoring of blood\nglucose by a surrogate or reside in group\nhomes or assisted living centers areother populations for which CGM mayplay a use... | [
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The availability of accurate CGM devi-\nces that can communicate with insulinpumps through Bluetooth has enabledthe development of advanced insulindelivery algorithms for pumps. These al-\ngorithms fall into two categories: pre-\ndictive low-glucose suspend algorithmsthat automatically shut off insulin deliv-ery if a h... | [
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and hybrid closed-loop algorithms that\nautomatically adjust insulin infusion ratesb a s e do nf e e d b a c kf r o maC G Mt ok e e pglucose levels in a goal range. Advanced\ninsulin delivery devices have been shownto improve glycemic outcomes in both\nchildren and adults with type 1 diabetes. | [
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children and adults with type 1 diabetes.\nMost trials of these devices have includeda broad range of people with type 1 dia-\nbetes but relatively few older adults. Re-\ncently, two small randomized controlledtrials in older adults have been published.\nThe Older Adult Closed Loop (ORACL) trial\nin 30 older adults (me... | [
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... |
in 30 older adults (mean age 67 years)\nwith type 1 diabetes found that an auto-\nmated insulin delivery (AID) strategy wasassociated with signi ficant improvements\nin time in range compared with sensor-augmented pump therapy (44). More-over, they found small but signi ficant de- | [
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creases in hypoglycemia with the AIDstrategy. Boughton et al. (45) reportedresults of an open-label, crossover de-\nsign clinical trial in 37 older adults\n($60 years) in which 16 weeks of\ntreatment with a hybrid closed-loopadvanced insulin delivery system wascompared with sensor-augmented pump\ntherapy. They found th... | [
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therapy. They found that hybrid closed-\nloop insulin delivery improved the pro-portion of time glucose was in range\nlargely due to decreases in hyperglyce-\nmia. In contrast to the ORACL study, nosignifi cant differences in hypoglycemia\nwere observed. Both studies enrolledolder individuals whose blood glucose\nwas re... | [
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was relatively well managed (mean A1C\n/C247 . 4 % ) ,a n db o t hu s e dac r o s s o v e rd e -\nsign comparing hybrid closed-loop insulindelivery to sensor-augmented pump ther-\napy. These trials provide the first evidence\nthat older individuals with long-standing\ntype 1 diabetes can successfully use ad-\nvanced ins... | [
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0.0033... |
vanced insulin delivery technologies to im-\nprove glycemic outcomes, as has been\nseen in younger populations. A recent realworld evidence analysis of a Medicare\npopulation (n = 4,243, 89% with type 1 di-\nabetes, mean age 67.4 years) also indi-\nc a t e dt h a ti n i t i a t i n gh y b r i dc l o s e d - l o o p | [
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c a t e dt h a ti n i t i a t i n gh y b r i dc l o s e d - l o o p\ninsulin delivery was associated with im-\nprovements in mean glucose and a 10%increase in time in range (46). Use of such\ntechnologies should be periodically reas-\nsessed, as the burden may outweigh the\nbenefits in those with declining cognitive\nor... | [
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0.0765011310... |
or functional status.\nTREATMENT GOALS\nRecommendations\n13.8a Older adults with diabetes\nwho are otherwise healthy with fewS246 Older Adults Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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and stable coexisting chronic illnesses\nand intact cognitive function and func-tional status should have lower glyce-mic goals (such as A1C <7.0–7.5%\n[<53–58 mmol/mol]). C\n13.8b Older adults with diabetes and | [
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[<53–58 mmol/mol]). C\n13.8b Older adults with diabetes and\nintermediate or complex health areclinically heterogeneous with variablelife expectancy. Selection of glycemicgoals should be individualized, withless stringent goals (such as A1C <8.0%\n[<64 mmol/mol]) for those with signif- | [
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[<64 mmol/mol]) for those with signif-\nicant cognitive and/or functional limi-tations, frailty, severe comorbidities,and a less favorable risk-to-bene fitr a -\ntio of diabetes medications. C\n13.8c Older adults with very complex\nor poor health receive minimal bene-fit from stringent glycemic control, | [
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and clinicians should avoid relianceon glycemic goals and instead focuson avoiding hypoglycemia and symp-tomatic hyperglycemia. C\n13.9 Screening for diabetes complica- | [
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13.9 Screening for diabetes complica-\ntions should be individualized in olderadults with diabetes. Particular atten-tion should be paid to complicationsthat would lead to impairment of func-tional status or quality of life. C\n13.10 Treatment of hypertension to\nindividualized goal levels is indi-cated in most older a... | [
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0.01291... |
13.11 Treatment of other cardiovas-\ncular risk factors should be individu-alized in older adults with diabetes,considering the time frame of bene fit.\nLipid-lowering therapy and antiplate-let agents may bene fit those with life\nexpectancies at least equal to thetime frame of primary prevention orsecondary intervention... | [
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0.00... |
The care of older adults with diabetes is\ncomplicated by their clinical, cognitive,\nand functional heterogeneity and their\nvaried prior experience with disease\nmanagement. Some older individuals\nmay have developed diabetes years ear-\nlier and have signi ficant complications,\nothers are newly diagnosed and may\nha... | [
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0.005534... |
have had years of undiagnosed diabetes\nwith resultant complications, and still,other older adults may have truly recent-\nonset disease with few or no complica-\ntions (47). Some older adults with dia-\nbetes have other underlying chronic\nconditions, substantial diabetes-relatedcomorbidity, limited cognitive or physi... | [
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functioning, or frailty (48,49). Other olderindividuals with diabetes have little co-\nmorbidity and are active.\nLife expectancies are highly variable\nbut are often longer than clinicians real-ize. Multiple prognostic tools for life ex-\npectancy for older adults are available(50,51). Notably, the Life Expectancy Es- | [
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0.010017... |
timator for Older Adults with Diabetes\n(LEAD) tool was developed and vali-\ndated among older adults with diabetes,\nand a high risk score was strongly asso-ciated with having a life expectancy of\n<5 years (52). These data may be a use-\nful starting point to inform decisionsabout selecting less stringent glycemic | [
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goals (52,53). Older adults also vary intheir preferences for the intensity and\nmode of glucose management (54).\nHealth care professionals caring for older\nadults with diabetes must take this het-\nerogeneity into consideration when set-ting and prioritizing treatment goals (9,10)\n(Table 13.1 ). In addition, older ... | [
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(Table 13.1 ). In addition, older adults with\ndiabetes should be assessed for diseasetreatment and self-management knowl-\nedge, health literacy, and mathematicalliteracy (numeracy) at the onset of treat-\nment. See Fig. 6.2 for individual/disease-\nrelated factors to consider when determin-ing individualized glycemic... | [
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A1C may have limitations in those\nwho have medical conditions that im-pact red blood cell turnover (see Sec-\ntion 2, “Diagnosis and Classi fication of\nDiabetes, ”for additional details on the\nlimitations of A1C) (55). Many condi-tions associated with increased red blood\ncell turnover, such as hemodialysis, recent | [
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cell turnover, such as hemodialysis, recent\nblood loss or transfusion, or erythropoie-tin therapy, are commonly seen in older\nadults and can falsely increase or decrease\nA1C. In these instances, blood glucose\nmonitoring and/or CGM should be used\nfor goal setting ( Table 13.1). Serum gly-\ncated protein assays (fru... | [
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cated protein assays (fructosamine and\nglycated albumin) may also be useful for\nglycemic monitoring in conjunction with\nother measures (see Section 6, “Glycemic\nGoals and Hypoglycemia ”)( 5 6–60).\nOlder Adults With Good Functional\nStatus and Without Complications\nThere are few long-term studies in older\nadults ... | [
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adults demonstrating the bene fits of\nintensive glycemic, blood pressure, andlipid management. Older adults whocan be expected to live long enough to\nrealize the bene fits of long-termintensive diabetes management, who | [
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realize the bene fits of long-termintensive diabetes management, who\nhave good cognitive and physicalf u n c t i o n ,a n dw h oc h o o s et od os ov i ashared decision-making may be treatedusing therapeutic interventions andgoals similar to those for younger adultswith diabetes ( Table 13.1 ).\nAs for all people with ... | [
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As for all people with diabetes, diabe-\ntes self-management education and on-going diabetes self-management supportare vital components of diabetes carefor older adults and their caregivers.Self-management knowledge and skillsshould be reassessed when treatment\nplan changes are made or an individual ’s\nfunctional ab... | [
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functional abilities diminish. In addition,\ndeclining or impaired ability to performdiabetes self-care behaviors may be anindication that an older person with dia-betes needs a referral for cognitive andphysical functional assessment, using age-\nnormalized evaluation tools, as well as\nhelp establishing a support str... | [
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help establishing a support structure fordiabetes care (3,28).\nOlder Adults With Complications and\nReduced Functionality\nOlder adults with diabetes categorized as\nhaving complex or intermediate health\n(Table 13.1 ) are heterogeneous with re-\nspect to their function and life expectancy(61–6 3 ) .B a s e do nc o n ... | [
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mortality and time to bene fit, some peo-\nple in this category with shorter life expec-tancy will have less bene fitf r o mg l u c o s e | [
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lowering and should have less stringentg l y c e m i cg o a l s( 6 4 ) .T h i si se s p e c i a l l yt r u efor individuals with advanced diabetescomplications, life-limiting comorbid ill-nesses, frailty, or substantial cognitive orfunctional impairments. These individualsare also more likely to suffer serious ad- | [
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verse effects of therapeutics, such as\nhypoglycemia (65). However, those withpoorly managed diabetes may be subjectto acute complications of diabetes, in-cluding dehydration, poor wound healing,and hyperglycemic hyperosmolar coma.Glycemic goals should, at a minimum, avoid\nthese consequences. Factors to consider | [
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0.04922795668244362,
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0.0004483... |
these consequences. Factors to consider\nfor individualizing glycemic goals are out-lined in Fig. 6.2 . Clinicians should also con-\nsider the balance of risks and bene fits of an\nindividual ’s diabetes medications, including\ndisease-specifi cb e n e fits (such as reducing | [
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disease-specifi cb e n e fits (such as reducing\nsymptomatic heart failure) and burdenssuch as hypoglycemia risk, tolerability, dif fi-\nculties of administration, and financial cost.\nIn addition, attention to oral health, footdiabetesjournals.org/care Older Adults S247\n©AmericanDiabetesAssociation | [
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care, fall prevention, and early detection of\ndepression will improve quality of life.\nWhile Table 13.1 provides overall guid-\nance for identifying complex and verycomplex patients, there is not yet globalconsensus on geriatric patient classi fica-\ntion. Ongoing empiric research on the\nclassification of older adults... | [
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0.03961408883333206,
0.06080476939678192,
0.006128337699919939,
-0.00074... |
classification of older adults with diabetes\nbased on comorbid illness has repeatedly | [
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based on comorbid illness has repeatedly\nfound three major classes of patients: ahealthy, a geriatric, and a cardiovascularclass (9,61,66). The geriatric class has thehighest prevalence of obesity, hyperten-sion, arthritis, and incontinence, and thecardiovascular class has the highest prev-alence of myocardial infarct... | [
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0.055661942809820175,
-0.040182143449783325,
... |
failure, and stroke. Compared with the\nhealthy class, the cardiovascular class hasthe highest risk of frailty and subsequentmortality. Additional research is neededto develop a reproducible classifi cation\nscheme to distinguish the natural history\nof disease as well as differential response\nto glucose management and... | [
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0.04347057640552521,
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0.02877718023955822,
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0.06998023390769958,
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to glucose management and speci fic\nglucose-lowering agents (67).\nVulnerable Older Adults at the End of\nLife\nFor people with diabetes receiving pallia-\ntive care and end-of-life care, the focusshould be to avoid hypoglycemia andsymptomatic hyperglycemia while reduc-ing the burdens of glycemic management.Thus, as or... | [
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0.024322429671883583,
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0.00668... |
agents will have to be deintensi fied or dis-\ncontinued. For a dying person, most agents\nfor type 2 diabetes may be removed (68).There is, however, no consensus for themanagement of type 1 diabetes in thisscenario (69). See the section\nEND-OF-LIFE\nCAREbelow for additional information.\nBeyond Glycemic Management | [
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0.0559... |
CAREbelow for additional information.\nBeyond Glycemic Management\nAlthough minimizing hyperglycemia maybe important in older individuals with di-abetes, greater reductions in morbidity\nand mortality are likely to result from a\nclinical focus on comprehensive cardio-vascular risk factor modifi cation. There is | [
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strong evidence from clinical trials of thevalue of treating hypertension in olderadults (70,71), with treatment of hyper-tension to individualized target levels in-dicated in most. There is less evidence\nfor lipid-lowering therapy and aspirin\ntherapy, although the benefi ts of these | [
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therapy, although the benefi ts of these\ninterventions for primary and secondaryprevention are likely to apply to olderTable 13.1 —Framework for considering treatment goals for glycemia, blood pressure, and dyslipidemia in older adults with\ndiabetes\nCharacteristics and\nhealth status of person\nwith diabetes Rational... | [
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0.00802211556583643,
-0.08121174573898315,
-0.017768919467926025,
-0.08386170864105225,
0.03437256067991257,
0.03719356283545494,
0.08214389532804489,
-0.05502254515886307,
-0.07142698764801025,
0.01535650622099638,
0.06663770973682404,
-0.08866941183805466,
-0.023418... |
with diabetes RationaleReasonable A1C\ngoal*Fasting or\npreprandial\nglucose Bedtime glucoseBlood\npressure Lipids\nHealthy (few coexisting\nchronic illnesses,\nintact cognitive and\nfunctional status)Longer remaining life\nexpectancy<7.0–7.5%\n(<53–58\nmmol/mol)80–130 mg/dL\n(4.4–7.2\nmmol/L)80–180 mg/dL\n(4.4–10.0\nm... | [
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-0.014018022455275059,
-0.07369868457317352,
0.041864633560180664,
-0.06111181154847145,
-0.045166898518800735,
0.015259500592947006,
0.07309916615486145,
-0.045649103820323944,
-0.034357570111751556,
0.006994116120040417,
-0.01478672120720148,
-0.06871714442968369,
0.... |
mmol/L)80–180 mg/dL\n(4.4–10.0\nmmol/L)<130/80\nmmHgStatin, unless\ncontraindicated\nor not tolerated\nComplex/intermediate\n(multiple coexistingchronic illnesses †or\ntwo or more\ninstrumental ADL\nimpairments ormild to moderate\ncognitive\nimpairment)Variable life\nexpectancy.Individualize goals,considering:\n/C15Sev... | [
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-0.001667488133534789,
-0.028199348598718643,
0.024612972512841225,
-0.0674939826130867,
-0.005097794812172651,
0.010373091325163841,
0.1592310220003128,
-0.02938336506485939,
-0.0237476397305727,
0.03633548319339752,
-0.02771833725273609,
-0.02144988812506199,
0.02480... |
/C15Severity ofcomorbidities\n/C15Cognitive and\nfunctional limitations\n/C15Frailty\n/C15Risk-to-bene fit ratio\nof diabetes\nmedications\n/C15Individual preference<8.0%\n(<64 mmol/mol)90–150 mg/dL\n(5.0–8.3\nmmol/L)100–180 mg/dL\n(5.6–10.0\nmmol/L)<130/80\nmmHgStatin, unless\ncontraindicated\nor not tolerated\nVery co... | [
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0.05896423012018204,
-0.022793538868427277,
-0.028659198433160782,
0.0040061515755951405,
0.14597129821777344,
-0.04496916010975838,
-0.04215948283672333,
-0.03359805420041084,
-0.04443113133311272,
-0.06176549941301346,
... |
contraindicated\nor not tolerated\nVery complex/poor\nhealth (LTC or\nend-stage chronicillnesses‡ or\nmoderate to severe\ncognitive impairment\nor two or more ADLimpairments)Limited remaining life\nexpectancy makesbene fit minimalAvoid reliance on\nA1C; glucosecontrol decisionsshould be basedon avoiding\nhypoglycemia\na... | [
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0.019246067851781845,
-0.05629442259669304,
0.052349019795656204,
-0.04905146732926369,
0.011243539862334728,
0.032263368368148804,
0.13677123188972473,
-0.06295794248580933,
-0.03516453504562378,
0.0070101735182106495,
0.012595844455063343,
-0.02946254424750805,
0.03... |
hypoglycemia\nand symptomatichyperglycemia100–180 mg/dL\n(5.6–10.0\nmmol/L)110–200 mg/dL\n(6.1–11.1\nmmol/L)<140/90\nmmHgConsider likelihood\nof bene fit with\nstatin | [
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-0.006010598037391901,
-0.02370220422744751,
0.0778566524386406,
0.12988553941249847,
-0.050353292375802994,
0.00323413941077888,
0.012724300846457481,
-0.03950288146734238,
-0.020522531121969223,
-0.03... |
This table represents a consensus framework for considering treatment goals for glycemia, blood pressure, and dyslipidemia in older adultswith diabetes. The characteristic categories are general concepts. Not every individual will clearly fall into a particular category. Considerationof individual and caregiver prefere... | [
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0.038532041013240814,
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0.04928981885313988,
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0.03745042532682419,
0.05775589868426323,
0.05970166251063347,
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-0.049705374985933304,
-0.0013980576768517494,
0.031895000487565994,
-0.04024361073970795,
-0.0548... |
individual and caregiver preferences is an important aspect of treatment individualization. Additionally, an individual ’s health status and | [
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0.059997912496328354,
0.06900990754365921,
0.026028072461485863,
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-0.03346581012010574,
0.021886326372623444,
0.08929285407066345,
-0.0796329528093338,
-0.0... |
preferences may change over time. ADL, activities of daily living; LTC, long-term care. *A lower A1C goal may be set for an individual ifachievable without recurrent or severe hypoglycemia or undue treatment burden. †Coexisting chronic illnesses are conditions serious enough | [
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0.09574659168720245,
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0.0021079694852232933,
0.07895554602146149,
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0.057922571897506714,
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-0.01... |
to require medications or lifestyle management and may include arthritis, cancer, heart failure, depression, emphysema, falls, hypertension,incontinence, stage 3 or worse chronic kidney disease, myocardial infarction, and stroke. “Multiple ”means at least three, but many individu- | [
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0.0018490820657461882,
0.0013026229571551085,
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0.00022727252508047968,
-0.03313753381371498,
0.03859400376677513,
-0.037632327526807785,
-0.0776965320110321,
0.014471863396465778,
0.007425784599035978,
0.03428908810019493,
-0.... |
als may have five or more (74). ‡The presence of a single end-stage chronic illness, such as stage 3 –4 heart failure or oxygen-dependent lung\ndisease, chronic kidney disease requiring dialysis, or uncontrolled metastatic cancer, may cause signi ficant symptoms or impairment of func- | [
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-0.07695595920085907,
0.020148735493421555,
0.008828986436128616,
-0.03243499994277954,
-0.05380925163626671,
-0.02231501042842865,
0.03092728555202484,
-0.01402189303189516,
-0.01855836622416973,
0.0009985025972127914,
0.021805619820952415,
-0.0021910492796450853,
-0... |
tional status and signi ficantly reduce life expectancy. Adapted from Kirkman et al. (3).S248 Older Adults Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
0.0291613657027483,
0.019712349399924278,
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0.04640573635697365,
-0.00047152151819318533,
0.07278555631637573,
-0.019158337265253067,
0.043778982013463974,
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0.0021501483861356974,
0.00949651189148426,
0.05785118043422699,
-0.002386431209743023,
-0.0... |
adults whose life expectancies equal or\nexceed the time frames of the clinical\ntrials (72). In the case of statins, thefollow-up time of clinical trials rangedfrom 2 to 6 years. While the time frameo ft r i a l sc a nb eu s e dt oi n f o r mt r e a t m e n tdecisions, a more specifi cc o n c e p ti st h e\ntime to ben... | [
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0.032024312764406204,
-0.07915874570608139,
0.017040031030774117,
0.03994816914200783,
0.023067496716976166,
-0.10557825118303299,
0.12145957350730896,
0.025478582829236984,
0.01415793877094984,
0.05593297258019447,
0.06101153790950775,
0.027757924050092697,
0.0482339... |
time to bene fit for a therapy. For statins,\na meta-analysis of the previously men-tioned trials showed that the time tobenefiti s2 . 5y e a r s( 7 3 ) .\nLIFESTYLE MANAGEMENT\nRecommendations\n13.12 Optimal nutrition and protein in-\ntake is recommended for older adults | [
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0.007511594798415899,
-0.08523550629615784,
0.028006765991449356,
0.02013552375137806,
0.08444094657897949,
-0.020199332386255264,
0.14764077961444855,
-0.06041084975004196,
0.012804464437067509,
-0.020971274003386497,
0.051408689469099045,
-0.005418275948613882,
0.04... |
take is recommended for older adults\nwith diabetes; regular exercise, includ-ing aerobic activity, weight-bearing exer-cise, and/or resistance training, shouldbe encouraged in all older adults withdiabetes who can safely engage in suchactivities. B\n13.13 For older adults with type 2 di- | [
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0.0009872507071122527,
-0.001223047380335629,
0.020316777750849724,
-0.03468047454953194,
0.018353063613176346,
0.07226768881082535,
0.04612378776073456,
-0.07721119374036789,
-0.01477679144591093,
-0.016247186809778214,
0.08230381458997726,
-0.07653136551380157,
0.0... |
13.13 For older adults with type 2 di-\nabetes, overweight/obesity, and ca-pacity to safely exercise, an intensivelifestyle intervention focused on die-\ntary changes, physical activity, and\nmodest weight loss (e.g., 5 –7%) should\nbe considered for its bene fits on qual- | [
-0.021907765418291092,
0.06636083126068115,
-0.009516982361674309,
-0.02992645464837551,
-0.07036948204040527,
0.023584607988595963,
-0.0007952018058858812,
0.05481754243373871,
-0.09618394076824188,
-0.032579466700553894,
0.05646103620529175,
0.028261763975024223,
-0.092973493039608,
-0.0... |
be considered for its bene fits on qual-\nity of life, mobility and physical func-tioning, and cardiometabolic risk factorcontrol. A\nLifestyle management in older adults\nshould be tailored to frailty status. Dia-\nbetes in the aging population is associ-ated with reduced muscle strength, poormuscle quality, and accele... | [
-0.010882889851927757,
0.04509488865733147,
-0.07770538330078125,
0.022531826049089432,
-0.09032946079969406,
0.009058679454028606,
0.07092255353927612,
0.022738272324204445,
-0.08520370721817017,
-0.02340884692966938,
0.010410215705633163,
0.05452479049563408,
-0.03419838473200798,
0.0055... |
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