Treatment
10
Role of the Endocrinologist and Diabetes Care Specialist
➤ In patients aged 65 years and older with newly diagnosed diabetes,
ES advises that an endocrinologist or diabetes care specialist should work
with the primary care provider, a multidisciplinary team, and the patient in
the development of individualized diabetes treatment goals. (UGPS)
➤ In patients aged 65 years and older with diabetes, an endocrinologist or
diabetes care specialist should be primarily responsible for diabetes care
if the patient has type 1 diabetes, or requires complex hyperglycemia
treatment to achieve treatment goals, or has recurrent severe
hypoglycemia, or has multiple diabetes complications. (UGPS)
Treatment of Hyperglycemia
Setting Glycemic Targets and Goals
➤ In patients aged 65 years and older with diabetes, ES recommends
that outpatient diabetes regimens be designed specifically to minimize
hypoglycemia. (1|⊕⊕⊕
)
Technical Remark: Although evidence for specific targets is lacking, glycemic targets
should be tailored to overall health and management strategies (e.g., whether or not a
medication that can cause hypoglycemia is used) (see Table 3).
Assessing Glycemia
➤ In patients aged 65 years and older with diabetes who are treated with
insulin, ES recommends frequent fingerstick glucose monitoring and/or
continuous glucose monitoring (to assess glycemia) in addition to HbA1c.
(1|⊕⊕
)
Lifestyle Interventions
➤ In patients aged 65 years and older with diabetes who are ambulatory,
ES recommends lifestyle modification as the first-line treatment for
hyperglycemia. (1|⊕⊕⊕⊕)
➤ In patients aged 65 years and older with diabetes, ES recommends
assessing nutritional status to detect and manage malnutrition. (1|⊕⊕⊕⊕)
Technical Remark: Nutritional status can be assessed using validated tools such as the
Mini Nutritional Assessment (MNA) and Short Nutritional Assessment Questionnaire
(SNAQ+65).
➤ In patients aged 65 years and older with diabetes and frailty, ES suggests
the use of diets rich in protein and energy to prevent malnutrition and
weight loss. (2|⊕⊕
)
