Diabetes Management in the Very Elderly: An Integrative Review of Glycemic Guidelines and Assessment of Current Practice for the Treatment of Diabetes in the Elderly

Wednesday, 24 July 2013: 10:50 AM

Charlotte K. Mason, MS, FNP-BC
Jackson Whole Family Health, Jackson, WY

Learning Objective 1: The learner will be able to identify current guidelines for diabetes management in the elderly.

Learning Objective 2: The learner will be able to list qualities unique to the elderly that impact the ability to adhere to current guidelines.

  1. To explore existing literature and current practice regarding treatment of diabetes in the population over age 75.
  2. To propose individualized clinical guideline recommendations for care of the elderly with diabetes.

Methods: A  review of literature was collected via search of online databases.  A questionnaire was administered to local providers responsible for the care of elderly diabetics to explore how decisions are made regarding diabetes care.

Results: Three themes  identified; frailty, glycemic recommendations, and guidelines.

General consensus: Healthy elderly should strive for glycemic goals established for younger diabetics.  The frail elderly were recommended an A1C <8%.  A single study explored outcomes of elderly diabetics with various A1C levels.  Results suggested that A1C levels between 8% and 8.9% were optimal.

Guidelines agreed that maintaining glycemic targets leads to decreased morbidity and mortality.  All recommended optimizing lifestyle, avoiding obesity, tobacco cessation, and exercise for diabetics.  A major limitation of the literature was lack of scientific data to support recommendations for the elderly.

Questionnaire responses:

  1. 20.5% of offices have a written protocol elderly patients with diabetes
  2. 92.7% found guidelines helpful.
  3. 78.5% reported that preventing hypoglycemia was a primary concern.
  4. 52.5% do not treat elderly diabetics the same as younger diabetics.
  5. 18.1 percent reported an A1C <7.0% was optimal in the elderly
  6. 7.6%, stated 7.0% to 7.9%.
  7. 23.4 percent state 8.0%.

Conclusion: Individualize treatment of diabetes in the elderly.  Providers should consider quality of life.  Aggressive pursuit of an A1C of < 7% not recommended.  Patient centered care and patient goals should guide management.


  1. Individual assessment.
  2. Assess comorbid conditions.
  3. Assess risk of hypoglycemia.
  4. Avoidance of “diabetic diet”
  5. Exercise
  6. Reassessment of medications
  7. Evaluation of limitations.
  8. Simplification.
  9. Relaxed A1C guidelines