Diabetes

Diabetes mellitus is a prominent concern in post-acute and long-term care (PALTC) settings, given its prevalence among older adults and its potential for severe complications. In the geriatric population, Type 2 diabetes is overwhelmingly predominant compared to Type 1 diabetes, and age-specific considerations play a pivotal role in its management.

Older adults with diabetes are at heightened risk for both microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (coronary artery disease, peripheral arterial disease, cerebrovascular disease) complications. Moreover, atypical presentations, including recurrent infections or cognitive changes, may be the primary manifestations of hyperglycemia in this age group.

Effective diabetes management requires a balanced and team-based approach. Glycemic targets should be individualized, considering the patient's overall health status, comorbid conditions, life expectancy, and risk of hypoglycemia.  

While tight glucose control can delay or prevent complications, it can increase the risk of hypoglycemia, which is particularly deleterious in older adults. This necessitates a shift from a strict HbA1c-based approach to a more holistic assessment encompassing postprandial glucose spikes, glycemic variability, and patient well-being.