Guidelines Issued on Managing Diabetes in Older Adults

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

The Endocrine Society has issued guidelines on screening for and treating diabetes in patients aged 65 and older. They were presented on Saturday at the group's annual meeting and published in the Journal of Clinical Endocrinology & Metabolism.

Among the highlights:

• Outpatient diabetes regimens should be geared toward minimizing risk for hypoglycemia. Accordingly, first-line treatment should be metformin; oral agents with high risk for hypoglycemia should be avoided (e.g., sulfonylureas and glinides); and insulin should be used sparingly.

• In patients with prediabetes, focus on lifestyle modification; metformin is not recommended for this population.

• Diabetic patients should be screened periodically for cognitive impairment. For those who screen positive, diabetes regimens should be simplified to facilitate adherence and help prevent treatment-related complications; glycemic targets should also be more lenient.

The document includes a useful algorithm for determining "reasonable" glucose and hemoglobin A1c targets based on the patient's overall health and medication regimen.