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supporting its ef ficacy in healing chronic\nDFUs at 12 weeks (96,97,106 –110) ThreeTable 12.2 —Categories of advanced wound therapies\nNegative-pressure wound therapy\nStandard electrically powered\nMechanically powered\nOxygen therapies\nHyperbaric oxygen therapy\nTopical oxygen therapy\nOxygen-releasing sprays, dress... | [
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0.023501545190811157,
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0.07... |
Topical oxygen therapy\nOxygen-releasing sprays, dressings\nBiophysical\nElectrical stimulation, diathermyPulsed electromagnetic fields, pulsed radiofrequency energy\nLow-frequency noncontact ultrasoundExtracorporeal shock wave therapy\nGrowth factors\nBecaplermin: platelet-derived growth factorFibroblast growth factor\... | [
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0.09950784593820572,
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Epidermal growth factor\nAutologous blood products\nPlatelet-rich plasmaLeukocyte, platelet, fibrin multilayered patches\nWhole blood clot\nAcellular matrix tissues\nXenograft dermis\nBovine dermis\nXenograft acellular matrices\nSmall intestine submucosaPorcine urinary bladder matrix\nOvine forestomachEquine pericardium... | [
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Ovine forestomachEquine pericardiumFish skin graft\nBovine collagen\nBilayered dermal regeneration matrix\nHuman dermis productsHuman pericardium\nPlacental tissues\nAmniotic tissues/amniotic fluid\nUmbilical cord\nBioengineered allogeneic cellular therapies\nBilayered skin equivalent (human keratinocytes and fibroblasts... | [
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Bilayered skin equivalent (human keratinocytes and fibroblasts)\nDermal replacement therapy (human fibroblasts)\nStem cell therapies\nAutogenous: bone marrow –derived stem cells\nAllogeneic: amniotic matrix with mesenchymal stem cells\nMiscellaneous active dressings\nHyaluronic acid, honey dressings, etc.Sucrose octasulf... | [
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Hyaluronic acid, honey dressings, etc.Sucrose octasulfate dressing\nAdapted with permission from Frykberg and Banks (95).S240 Retinopathy, Neuropathy, and Foot Care Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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13. Older Adults: Standards of\nCare in Diabetes— 2024\nDiabetes Care 2024;47(Suppl. 1):S244 –S257 |https://doi.org/10.2337/dc24-S013American Diabetes Association\nProfessional Practice Committee *\nThe American Diabetes Association (ADA) “Standards of Care in Diabetes” in-\ncludes the ADA ’s current clinical practice ... | [
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provide the components of diabetes care, general treatment goals and guide- | [
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lines, and tools to evaluate quality of care. Members of the ADA ProfessionalPractice Committee, an interprofessional expert committee, are responsible forupdating the Standards of Care annually, or more frequently as warranted. For adetailed description of ADA standards, statements, and reports, as well as the | [
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evidence-grading system for ADA ’s clinical practice recommendations and a full\nlist of Professional Practice Committee members, please refer to Introduction\nand Methodology. Readers who wish to comment on the Standards of Care areinvited to do so at professional.diabetes.org/SOC.\nRecommendations | [
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Recommendations\n13.1 Consider the assessment of medical, psychological, functional (self-\nmanagement abilities), and social domains in older adults with diabetes to\nprovide a framework to determine goals and therapeutic approaches for diabetes\nmanagement. B\n13.2 Screen for geriatric syndromes (e.g., cognitive impa... | [
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urinary incontinence, falls, persistent pain, and frailty) and polypharmacy inolder adults with diabetes, as they may affect diabetes self-management anddiminish quality of life. B\nDiabetes is a highly prevalent health condition in the aging population. Over one- | [
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quarter of people over the age of 65 years have diabetes and one-half of olderadults have prediabetes (1,2). The number of older adults living with these condi-tions is expected to increase rapidly in the coming decades. Diabetes in olderadults is a highly heterogeneous condition. While type 2 diabetes predominates in | [
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the older population as in the younger population, improvements in insulin deliv- | [
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ery, technology, and care over the last few decades have led to increasing numbersof people with childhood and adult-onset type 1 diabetes surviving and thrivinginto their later decades. Diabetes management in older adults requires regular as-sessment of medical, psychological, functional, and social domains. When asse... | [
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functional, and social domains. When assessingolder adults with diabetes, it is important to accurately categorize the type of dia- | [
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betes as well as other factors, including diabetes duration, the presence of compli- | [
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cations, and treatment-related concerns, such as fear of hypoglycemia. Screeningfor diabetes complications in older adults should be individualized and periodicallyrevisited, as the results of screening tests may impact treatment goals and thera-peutic approaches (3 –5). Older adults with diabetes have higher rates of ... | [
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disability, accelerated muscle loss, and coexisting illnesses, such as hypertension,chronic kidney disease, coronary heart disease, and stroke, and of premature deaththan those without diabetes. At the same time, older adults with diabetes *A complete list of members of the American | [
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Diabetes Association Professional Practice Committeecan be found at https://doi.org/10.2337/dc24-SINT.\nDuality of interest information for each author is\navailable at https://doi.org/10.2337/dc24-SDIS.\nSuggested citation: American Diabetes Association | [
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Suggested citation: American Diabetes Association\nProfessional Practice Committee. 13. Older adults:Standards of Care in Diabetes —2024 .D i a b e t e s\nCare 2024;47(Suppl. 1):S244– S257 | [
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Care 2024;47(Suppl. 1):S244– S257\n© 2023 by the American Diabetes Association.Readers may use this article as long as thework is properly cited, the use is educationaland not for pro fit, and the work is not altered. | [
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More information is available at https://www.diabetesjournals.org/journals/pages/license.13. OLDER ADULTSS244 Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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also require greater caregiver support\nand are at greater risk than other older\nadults for several common geriatric syn-dromes such as cognitive impairment,depression, urinary incontinence, injuri-ous falls, persistent pain, and frailty aswell as polypharmacy (1). These condi-tions may impact older adults ’diabetes | [
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self-management abilities and qualityof life if left unaddressed (2,6,7). SeeSection 4, “Comprehensive Medical Evalua-\ntion and Assessment of Comorbidities, ”\nfor the full range of issues to considerwhen caring for older adults with diabetes.\nThe comprehensive assessment de- | [
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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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0.01529634... |
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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0.00801622774451971,
0.009914573... |
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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0.0... |
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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0.012631... |
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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0.00... |
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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0.009... |
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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0.035590227... |
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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0.009738535620... |
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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0.037... |
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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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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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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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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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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0.01... |
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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0.02551998943090439,
0.09404901415109634,
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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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0.0004483... |
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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