Oral agents and insulin in care of older adults with diabetes

Care for elderly patients with diabetes poses a unique clinical challenge (1). The management of older patients with diabetes is complicated by the medical and functional heterogeneity of this group (2,3). The heterogeneity of this population is a key consideration for clinicians developing intervention strategies and establishing clinical targets for elderly patients with diabetes (4-9). The examples of clinical and functional heterogeneity include: 1. Patients who have just shifted from impaired glucose tolerance to diabetes and have a few comorbidities but remain active with excellent functional status 2. Patients who have been recently diagnosed but have had significant hyperglycemia for many years and already have complications at diagnosis 3. Elderly who have developed diabetes in middle age and developed multiple related comorbidities over time 4. Patients who are disabled and frail, with advanced cognitive impairment, multiple comorbidities, and complications. Since many elderly diabetic patients are in between the stages described above, with mild or early functional limitations and multiple risks for worsening morbidity, they require an individualized plan based on their functional status and life expectancy (4,10).