What is the right strategy for managing diabetes in older adults? Do they require intensive diabetes management? The correct answer is – maybe! For purposes of this article, “older adult” is defined as a person who is 65 years of age or older. Older adults are not a homogeneous group so clinicians should consider medical, psychological, functional, and social aspects of the individual’s life when determining glycemic targets and interventions to help them achieve their goals1.
Treatment Varies Based on Condition
Older adults who are otherwise healthy without co-existing chronic illnesses and impaired cognitive function should have glycemic goals similar to other adults: A1C less than 7.0-7.5%1. However, treatment varies based on condition:
- Physically and cognitively healthy older adults with diabetes that are overweight can be encouraged to lose weight, which will provide benefits like lowered blood pressure, increased HDL cholesterol, reduced A1c, and reduced needs for medications1.
- Those with multiple chronic conditions, cognitive impairment, or functional dependence need less stringent glycemic control1. Intensive glycemic management is probably not a realistic goal when comorbidities affect quality and length of life and/or cognitive impairment makes it challenging for patients to follow complex medical regimens.
- Patients with very poor health or a limited life expectancy should focus on avoiding hypoglycemia and symptomatic hyperglycemia rather than tight glucose control, because there is no clear benefit to tight glycemic control in this group1.
- Weight loss is not a goal for those with signs of frailty.1 Frail individuals and/or those with pressure injuries, unintended weight loss, or severe swallowing problems are at risk of impaired nutritional status. For these individuals, a diabetes care plan should not include intentional weight loss or overly restrictive diets1.
Individualize Nutrition Care
Nutrition care should be tailored to an individual’s culture, preferences, and personal goals for all older adults, but especially those in in long-term care facilities. Quality of life is important when considering how aggressive an older individual and/or family should be in managing diabetes. Patients and/or families may be overly concerned with controlling blood sugars and imposing dietary restrictions that may no longer be necessary. It might be helpful to make patients aware that one of the goals of nutrition therapy is “to maintain the pleasure of eating by providing nonjudgmental messages about food choices while limiting food choices only when indicated by scientific evidence”2.
Encourage a Healthy Eating Pattern
Registered dietitian nutritionists (RDN) should encourage a healthy eating pattern that includes vegetables, fruit, legumes, lean protein sources and low-fat dairy foods and whole grains, and minimizes processed foods and sweetened beverages and desserts2. We find that many older patients in long term care facilities are relieved when given permission to enjoy some of their favorite foods without guilt, especially when they learn that, given their age and life span, there are probably no long-term consequences to elevated blood sugars that don’t cause any obvious symptoms.
Becky Dorner & Associates offers several CPE courses and webinars on diabetes management. You can also sort courses and webinars by topic (diabetes). Our Diet and Nutrition Care Manuals also include a chapter on Diabetes and a section on Diabetes Care for Older Adults.
References
- Older Adults-Standards of Medical Care in Diabetes-2022. Diabetes Care.2022;45(Supplement_1):S195–S207. https://doi.org/10.2337/dc22-S013. Accessed April 12, 2022.
- Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes—2022. Diabetes Care 2022;45(Supplement_1):S60–S82. https://doi.org/10.2337/dc22-S005.
