Update on diabetes in the elderly and in nursing home residents
Abstract
Diabetes is common in the elderly population and in nursing home residents. More than 20% of adults aged 65 to 75 years and 40% of adults older than 80 years suffer from diabetes. Physiological changes in elderly individuals, such as decreased physical activity, abdominal obesity, and increased inflammatory state, increase insulin resistance in peripheral tissue and reduce glucose-dependent insulin release, leading to carbohydrate intolerance and diabetes. The clinical presentation in the elderly and nursing home residents is frequently guided by the high rate of comorbidities such as hypertension, depression, and cardiovascular diseases. Treatment recommendations for glycemic control in elderly ambulatory patients are similar to those in long-term care facilities. Healthy patients with diabetes should aim for near-normal fasting plasma glucose and an HbA1C of about 7%; however, treatment goals must be individualized in patients with impaired cognitive and physical ability, reduced life expectancy, and heavy burden of comorbid disease. Elderly individuals and nursing home residents are at increased risk of hypoglycemia during pharmacological treatment. In general, a conservative and stepwise approach to the treatment of the elderly patient with diabetes is suggested. Treatment may be initiated with dietary and physical activity modification and with a single oral agent, followed by a combination of oral agents and insulin therapy if needed. Evidence from clinical trials indic…
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Older adults with diabetes in LTC have a disproportionately high number of clinical complications and comorbidities that can increase hypoglycemia risk, including impaired cognitive and renal function, slowed hormonal regulation and counterregulation, suboptimal hydration, variable appetite and nutritional intake, polypharmacy, and slowed intestinal absorption.
“They have a disproportionately high number of clinical complications and comorbidities that can increase hypoglycemia risk: impaired cognitive and renal function, slowed hormonal regulation and counterregulation, suboptimal hydration, variable appetite and nutritional intake, polypharmacy, and slowed intestinal absorption (128).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [128]
Older adults with diabetes in PALTC have a disproportionately high number of clinical complications and comorbidities that can increase hypoglycemia risk.
“They have a disproportionately high number of clinical complications and comorbidities that can increase hypoglycemia risk: impaired cognitive and renal function, slowed hormonal regulation and counterregulation, suboptimal hydration, variable appetite and nutritional intake, requirement for feeding assistance, polypharmacy, and slowed intestinal absorption (147).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [147]
Older adults with diabetes in PALTC are especially vulnerable to hypoglycemia.
“Older adults with diabetes in PALTC are especially vulnerable to hypoglycemia.”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [147]
Older adults with diabetes in PALTC are especially vulnerable to hypoglycemia.
“Older adults with diabetes in PALTC are especially vulnerable to hypoglycemia.”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [166]
They have a disproportionately high number of health conditions that can increase hypoglycemia risk: impaired cognitive and renal function, slowed hormonal regulation and counter-regulation, suboptimal hydration, variable appetite and nutritional intake, requirement for feeding assistance, polypharmacy, and slowed intestinal absorption.
“They have a disproportionately high number of health conditions that can increase hypoglycemia risk: impaired cognitive and renal function, slowed hormonal regulation and counter-regulation, suboptimal hydration, variable appetite and nutritional intake, requirement for feeding assistance, polypharmacy, and slowed intestinal absorption (166).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [166]
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Umpierrez, G. E., Cardona, S., Chachkhiani, D., Fayfman, M., Saiyed, S., Wang, H., Vellanki, P., Haw, J. S., Olson, D. E., Pasquel, F. J., et al. (2018) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.11.002 · Cited by 43 · see citing works
Self-citation
- Authors
- Migdal, A., Yarandi, S. S., Smiley, D., & Umpierrez, G. E.
- Affiliations
- Emory University (US)
- Corresponding author
- Umpierrez, Guillermo E.
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 12
- Issue
- 9
- Pages
- 627-632.e2
- ISSN
- 1525-8610 (ISSN-L)
- OpenAlex
- W1968902539
- Cited by
- 81
- References
- 11
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 6 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 7 · 2015: 8 · 2014: 7 · 2013: 13 · 2012: 8
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Medical Directors Association (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R03DK073190)
- National Center for Research Resources (M01RR000039)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- elderly diabetes, nursing home residents, insulin resistance, comorbidities, glycemic control, HbA1c targets, hypoglycemia risk, individualized treatment goals, stepwise treatment approach, oral antidiabetic drugs, insulin therapy, long-term care, cardiovascular risk
- MeSH terms
- Aged, Aged, 80 and over, Diabetes Mellitus, Female, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Nursing Homes
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