13
Eye Complications
➤ In patients aged 65 years and older with diabetes, ES recommends annual
comprehensive eye exams to detect retinal disease (1|⊕⊕⊕⊕).
Technical Remark: Screening and treatment should be conducted by an ophthalmologist
or optometrist in line with present-day standards.
Neuropathy, Falls, and Lower Extremity Problems
➤ In patients aged 65 years and older with diabetes and advanced chronic
sensorimotor distal polyneuropathy, ES suggests treatment regimens that
minimize fall risk, such as the minimized use of sedative drugs or drugs
that promote orthostatic hypotension and/or hypoglycemia. (2|⊕
)
➤ In patients aged 65 years and older with diabetes and peripheral
neuropathy with balance and gait problems, ES suggests referral to
physical therapy or a fall management program to reduce the risk of
fractures and fracture-related complications. (2|⊕
)
➤ In patients aged 65 years and older with diabetes and peripheral
neuropathy and/or peripheral vascular disease, ES suggests referral to a
podiatrist, orthopedist or vascular specialist for preventive care to reduce
the risk of foot ulceration and/or lower extremity amputation. (2|⊕⊕
)
Chronic Kidney Disease
➤ In patients aged 65 years and older with diabetes who are not on dialysis,
ES recommends annual screening for CKD with an eGFR and urine
albumin/creatinine ratio. (1|⊕⊕⊕⊕)
➤ In patients aged 65 years and older with diabetes who are in Group 3
(poor health) of the framework (see Table 3) and have a previous albumin/
creatinine ratio of <30 mg/g, ES suggests against additional annual
albumin creatinine ratio measurements. (2|⊕⊕
)
➤ In patients aged 65 years and older with diabetes and decreased eGFR,
ES recommends limiting the use or dosage of many classes of diabetes
medications to minimize the side effects and complications associated
with CKD. (1|⊕⊕
)
Technical Remark: Specific use/dosing guidance on each class of diabetes medication is
provided in Table 6.
