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Cited by 548Diabetes Treatment and ManagementDiabetes Management and ResearchPharmaceutical Practices and Patient Outcomes

The DOI matches its Crossref record; 144 of the 145 references it cites were found in a registry or an index; none of the 157 sources its claims cite is checked for support yet.

Diabetes in Older Adults: A Consensus Report

Open access
Sue Kirkman, M., Briscoe, Vanessa Jones, Clark, Nathaniel, Florez, Hermes, Haas, Linda B., Halter, Jeffrey B., Huang, Elbert S., Korytkowski, Mary T., Munshi, Medha N., Odegard, Peggy Soule, Pratley, Richard E., Swift, Carrie S.·2012·Journal of the American Geriatrics Society
DOI 10.1111/jgs.12035PMC PMC4525769
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Abstract

More than 25% of the U.S. population aged ≥ 65 years has diabetes mellitus (hereafter referred to as diabetes),1 and the aging of the overall population is a significant driver of the diabetes epidemic. Although the burden of diabetes is often described in terms of its impact on working-age adults, diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of institutionalization.2 Older adults with diabetes are at substantial risk for both acute and chronic microvascular and cardiovascular complications of the disease. Despite having the highest prevalence of diabetes of any age-group, older persons and/or those with multiple comorbidities have often been excluded from randomized controlled trials of treatments—and treatment targets—for diabetes and its associated conditions. Heterogeneity of health status of older adults (even within an age range) and the dearth of evidence from clinical trials present challenges to determining standard intervention strategies that fit all older adults. To address these issues, the American Diabetes Association (ADA) convened a Consensus Development Conference on Diabetes and Older Adults (defined as those aged ≥ 65 years) in February 2012. Following a series of scientific presentations by experts in the field, the writing group independently developed this consensus report to address the following questions: According to the most recent surveillance data, the prevalence of diabetes among U.S. adults aged ≥ 65 years varies from 22 to 33%, depending on the diagnostic criteria used. Postprandial hyperglycemia is a prominent characteristic of type 2 diabetes in older adults,3, 4 contributing to observed differences in prevalence depending on which diagnostic test is used.5 Using the hemoglobin A1C (A1C) or fasting plasma glucose (FPG) diagnostic criteria, as is currently done for national surveillance, one-third of older adults with diabetes are undiagnosed.1 The epidemic of type 2 diabetes is clearly linked to increasing rates of overweight and obesity in the U.S. population, but projections by the Centers for Disease Control and Prevention (CDC) suggest that even if diabetes incidence rates level off, the prevalence of diabetes will double in the next 20 years, in part due to the aging of the population.5 Other projections suggest that the number of cases of diagnosed diabetes in those aged ≥ 65 years will increase by 4.5-fold (compared to 3-fold in the total population) between 2005 and 2050.6 The incidence of diabetes increases with age until about age 65 years, after which both incidence and prevalence seem to level off (www.cdc.gov/diabetes/statistics). As a result, older adults with diabetes may either have incident disease (diagnosed at and after age 65 years) or long-standing diabetes with onset in middle age or earlier. Demographic and clinical characteristics of these two groups differ in a number of ways, adding to the complexity of making generalized treatment recommendations for older patients with diabetes. Older-age–onset diabetes is more common in non-Hispanic whites and is characterized by lower mean A1C and lower likelihood of insulin use than is middle-age–onset diabetes. Although a history of retinopathy is significantly more common in older adults with middle-age–onset diabetes than those with older-age onset, there is, interestingly, no difference in prevalence of cardiovascular disease (CVD) or peripheral neuropathy by age of onset.7 Older adults with diabetes have the highest rates of major lower-extremity amputation,8 myocardial infarction (MI), visual impairment, and end-stage renal disease of any age-group. Those aged ≥ 75 years have higher rates than those aged 65–74 years for most complications. Deaths from hyperglycemic crises also are significantly higher in older adults (although rates have declined markedly in the past 2 decades). Those aged ≥ 75 years also have double the rate of emergency department visits for hypoglycemia than the general population with diabetes.9 Although increasing numbers of individuals with type 1 diabetes are living into old age,10 this discussion of pathophysiology concerns type 2 diabetes—overwhelmingly the most common incident and prevalent type in older age-groups. Older adults are at high risk for the development of type 2 diabetes due to the combined effects of increasing insulin resistance and impaired pancreatic islet function with aging. Age-related insulin resistance appears to be primarily associated with adiposity, sarcopenia, and physical inactivity,11 which may partially explain the disproportionate success of the intensive lifestyle intervention in older participants in the Diabetes Prevention Program (DPP).12 However, age-related declines of pancreatic islet function4, 13 and islet proliferative capacity14, 15 have previously been described. Older adults are at high risk for both diabetes and prediabetes, with surveillance data suggesting that half of older

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This consensus report reviews epidemiology, prevention, treatment, and care of diabetes in older adults, emphasizing clinical heterogeneity and individualized goals. It concludes that evidence is limited for older and frail adults and recommends balancing treatment benefits against life expectancy, comorbidity, and functional status.

Key findings

  • Among U.S. adults over age 65, diabetes prevalence varies from 22% to 33% depending on diagnostic criteria; one-third of older adults with diabetes are undiagnosed using A1C or FPG criteria, and about half of older adults have prediabetes.
  • In the Diabetes Prevention Program, participants over age 60 had a 49% risk reduction at 10-year follow-up with lifestyle intervention versus 34% for the total cohort, but older participants did not appear to benefit from metformin.
  • ACCORD’s glucose-control arm was terminated after about 3 years because of excessive deaths in the intensive arm; older participants in both glycemic arms had approximately 50% higher rates of severe hypoglycemia than participants under age 65.
  • In 71,092 patients with type 2 diabetes aged ≥60 years, mortality had a U-shaped relationship with A1C: compared with A1C <6.0%, mortality risk was lower for A1C 6.0%–9.0% and higher at A1C ≥11.0%; risk of any endpoint became significantly higher at A1C ≥8.0%.

Methods

  • Design: consensus report and narrative review, not a primary research study; it synthesizes epidemiology, randomized trials, observational studies, and existing guidelines.
  • Data or sample: no primary sample; cited evidence includes national surveillance data, the DPP, UKPDS, ACCORD, ADVANCE, VADT, observational cohorts, and guidelines from ADA, AGS, VA/DOD, and the European Diabetes Working Party for Older People.
  • Main analysis: expert consensus synthesis with recommendations, including a framework based on Blaum et al. that classifies older patients into three health-status groups by comorbidity and functional impairment.

Limitations

  • The paper states that older and especially frail older adults have been excluded from most traditional randomized controlled trials, leaving large gaps in knowledge; there are essentially no directly applicable clinical trial data on glucose control for large segments of the older diabetes population.
  • The paper states that comparative effectiveness studies of diabetes medications in older adults are lacking, and many guideline recommendations are based on expert opinion.
  • Evident from the text: this is a consensus/narrative report without a described systematic search strategy or formal evidence-grading process, so recommendations reflect expert interpretation and may be subject to selection of cited evidence.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/jgs.12035

Cites

144 of 144 references verified0 citation errors · 0 not checkable

Statistics

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Verification

Claims the paper makes

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Show all 76 claims

  • It may state two separate claims as one. 61
  • Probably not a substantial claim. 19
  • The quote only partly states this claim. 1
73 of 73

  • The paper relies on this without support.

    High rates of unidentified cognitive deficits exist in older adults.

    “High rates of unidentified cognitive deficits in older adults suggest that it is important to screen for cognitive dysfunction periodically.”

  • The paper relies on this without support.

    Cognitive dysfunction makes it difficult for patients to perform complex self-care tasks such as glucose monitoring, changing insulin doses, or maintaining timing and content of diet appropriately.

    “Such dysfunction makes it difficult for patients to perform complex self-care tasks such as glucose monitoring, changing insulin doses, or maintaining timing and content of diet appropriately.”

  • The paper relies on this without support.

    Avoidance of severe hyperglycemia and hypoglycemia can decrease the risk of falls.

    “Avoidance of severe hyperglycemia and hypoglycemia can decrease the risk of falls.”

  • The paper relies on this without support.

    Older adults with diabetes are at high risk of polypharmacy, increasing the risk of drug side effects and drug-to-drug interactions.

    “Older adults with diabetes are at high risk of polypharmacy, increasing the risk of drug side effects and drug-to-drug interactions.”

  • The paper relies on this without support.

    In older adults, depression may remain undiagnosed if screening is not performed.

    “In older adults, depression may remain undiagnosed if screening is not performed.”

  • The paper relies on this without support.

    Urinary incontinence is common in older patients, especially women, with diabetes.

    “Urinary incontinence is common in older patients, especially women, with diabetes.”

  • The paper relies on this without support.

    Uncontrolled hyperglycemia can increase the amount and frequency of urination.

    “In addition to standard assessments and treatments for incontinence, clinicians should remember that uncontrolled hyperglyemia can increase the amount and frequency of urination.”

  • The paper relies on this without support.

    Though energy needs decline with age, macronutrient needs are similar throughout adulthood.

    “Though energy needs decline with age, macronutrient needs are similar throughout adulthood.”

  • The paper relies on this without support.

    Meeting micronutrient needs with lower caloric intake is challenging; therefore older adults with diabetes are at higher risk for deficiencies.

    “Meeting micronutrient needs with lower caloric intake is challenging; therefore older adults with diabetes are at higher risk for deficiencies.”

  • The paper relies on this without support.

    Older adults may be at risk for undernutrition due to anorexia, altered taste and smell, swallowing difficulties, oral/dental issues, and functional impairments leading to difficulties in preparing or consuming food.

    “Older adults may be at risk for undernutrition due to anorexia, altered taste and smell, swallowing difficulties, oral/dental issues, and functional impairments leading to difficulties in preparing or consuming food.”

  • The paper relies on this without support.

    Overly restrictive eating patterns, either self-imposed or provider-directed, may contribute additional risk for older adults with diabetes.

    “Overly restrictive eating patterns, either self-imposed or provider-directed, may contribute additional risk for older adults with diabetes.”

  • The paper relies on this without support.

    Overweight and obesity are prevalent among older adults.

    “Overweight and obesity are prevalent among older adults.”

  • The paper relies on this without support.

    Sarcopenia may occur in both over- and underweight older adults.

    “Sarcopenia may occur in both over- and underweight older adults.”

  • The paper relies on this without support.

    Many patients may have low health literacy and numeracy skills, or may be overwhelmed by the presence of multiple comorbidities.

    “Even in the absence of cognitive impairment, educators should consider that many patients may have low health literacy and numeracy skills, or may be overwhelmed by the presence of multiple comorbidities.”

  • The paper relies on this without support.

    Muscle mass and strength decline with age, and these decrements may be exacerbated by diabetes complications, comorbidities, and periods of hospitalization in older adults with diabetes.

    “Muscle mass and strength decline with age, and these decrements may be exacerbated by diabetes complications, comorbidities, and periods of hospitalization in older adults with diabetes.”

  • The paper relies on this without support.

    Even patients with poorer health status benefit from modest increases in physical activity.

    “Even patients with poorer health status benefit from modest increases in physical activity.”

  • The paper relies on this without support.

    Older patients are at increased risk for adverse drug events from most medications due to age-related changes in pharmacokinetics and pharmacodynamics affecting drug disposition.

    “Older patients are at increased risk for adverse drug events from most medications due to age-related changes in pharmacokinetics (in particular reduced renal elimination) and pharmacodynamics (increased sensitivity to certain medications) affecting drug disposition.”

  • The paper relies on this without support.

    The risk for medication-related problems is compounded by the use of complex regimens, high-cost therapies, and polypharmacy or medication burden.

    “The risk for medication-related problems is compounded by the use of complex regimens, high-cost therapies, and polypharmacy or medication burden.”

  • The paper relies on this without support.

    Comparative effectiveness studies of medications to treat diabetes in older adult populations are lacking.

    “Comparative effectiveness studies of medications to treat diabetes in older adult populations are lacking.”

  • The paper relies on this without support.

    Type 2 diabetes with onset later in life is characterized by prominent defects in beta cell function.

    “Type 2 diabetes with onset later in life is characterized by prominent defects in beta cell function, suggesting therapeutic attention to beta cell function and sufficiency of insulin release, as well as the traditional focus on hepatic glucose overproduction and insulin resistance.”

  • The paper relies on this without support.

    Metformin has low risk for hypoglycemia.

    “Metformin, often considered first-line therapy in type 2 diabetes. Its low risk for hypoglycemia may be beneficial in older adults, but gastrointestinal intolerance and weight loss from the drug may be detrimental in frail patients.”

  • The paper relies on this without support.

    Gastrointestinal intolerance and weight loss from metformin may be detrimental in frail patients.

    “Metformin, often considered first-line therapy in type 2 diabetes. Its low risk for hypoglycemia may be beneficial in older adults, but gastrointestinal intolerance and weight loss from the drug may be detrimental in frail patients.”

  • The paper relies on this without support.

    Metformin’s low cost may be a benefit in those on multiple medications or who are subject to the Medicare Part D “doughnut hole.”

    “Metformin’s low cost may be a benefit in those on multiple medications or who are subject to the Medicare Part D “doughnut hole.””

  • The paper relies on this without support.

    Sulfonylureas are a low-cost class of medications, but the risk of hypoglycemia with these agents may be problematic for older patients.

    “Sulfonylureas are also a low-cost class of medications, but the risk of hypoglycemia with these agents may be problematic for older patients.”

  • The paper relies on this without support.

    Glinides are dosed prior to meals and their short half-life may be useful for post-prandial hyperglycemia and impart lower risk for hypoglycemia than sulfonylureas, especially in patients who eat irregularly.

    “Glinides are dosed prior to meals and their short half-life may be useful for post-prandial hyperglycemia and impart lower risk for hypoglycemia than sulfonylureas, especially in patients who eat irregularly.”

  • The paper relies on this without support.

    Glinides' dosing frequency and high cost may be barriers.

    “Their dosing frequency and high cost may be barriers.”

  • The paper relies on this without support.

    Alpha-glucosidase inhibitors specifically target post-prandial hyperglycemia and have low hypoglycemia risk.

    “Alpha-glucosidase inhibitors specifically target post-prandial hyperglycemia and have low hypoglycemia risk, making them theoretically attractive for older patients.”

  • The paper relies on this without support.

    Alpha-glucosidase inhibitors' gastrointestinal intolerance may be limiting, frequent dosing adds to regimen complexity, and this class of medications is costly.

    “However, gastrointestinal intolerance may be limiting, frequent dosing adds to regimen complexity, and this class of medications is costly.”

  • The paper relies on this without support.

    Thiazolidinediones have associated risks of weight gain, edema, heart failure, bone fractures, and possibly bladder cancer.

    “Thiazolidinediones have associated risks of weight gain, edema, heart failure, bone fractures, and possibly bladder cancer, which may argue against their use in older adults.”

  • The paper relies on this without support.

    The use of rosiglitazone is now highly restricted.

    “The use of rosiglitazone use is now highly restricted.”

  • The paper relies on this without support.

    The thiazolidinedione class has traditionally been expensive, although the approval of generic pioglitazone may reduce its cost.

    “The class has traditionally been expensive, although the approval of generic pioglitazone may reduce its cost.”

  • The paper relies on this without support.

    DPP-4 inhibitors are useful for post-prandial hyperglycemia, impart little risk for hypoglycemia, and are well tolerated.

    “DPP-4 inhibitors are useful for post-prandial hyperglycemia, impart little risk for hypoglycemia, and are well tolerated, suggesting potential benefit for older patients.”

  • The paper relies on this without support.

    DPP-4 inhibitors' high cost may be limiting.

    “However, their high cost may be limiting.”

  • The paper relies on this without support.

    GLP-1 agonists target post-prandial hyperglycemia and impart low risk of hypoglycemia, but their associated nausea and weight loss may be problematic in frail older patients.

    “GLP-1 agonists also target post-prandial hyperglycemia and impart low risk of hypoglycemia, but their associated nausea and weight loss may be problematic in frail older patients.”

  • The paper relies on this without support.

    Injection therapy may add to regimen complexity, and GLP-1 agonists' very high cost may be problematic.

    “Injection therapy may add to regimen complexity, and their very high cost may be problematic.”

  • The paper relies on this without support.

    For some agents, dose reduction is required for renal dysfunction.

    “For some agents, dose reduction is required for renal dysfunction.”

  • The paper relies on this without support.

    Problems with vision or manual dexterity may be barriers to insulin therapy for some older adults.

    “Problems with vision or manual dexterity may be barriers to insulin therapy for some older adults.”

  • The paper relies on this without support.

    Pen devices improve ease of use but are more costly than use of vials and syringes.

    “Pen devices improve ease of use but are more costly than use of vials and syringes.”

  • The paper relies on this without support.

    Hypoglycemia risk (especially nocturnal) is somewhat lower with analog compared to human insulins, but the former are more expensive.

    “Hypoglycemia risk (especially nocturnal) is somewhat lower with analog compared to human insulins, but the former are more expensive.”

  • The paper relies on this without support.

    Insulin-induced weight gain is a concern for some patients, and the need for more blood glucose monitoring may increase treatment burden.

    “Insulin-induced weight gain is a concern for some patients, and the need for more blood glucose monitoring may increase treatment burden.”

  • The paper relies on this without support.

    Other approved therapies for which there is little evidence in older patients include colesevelam, bromocriptine, and pramlintide.

    “Other approved therapies for which there is little evidence in older patients include colesevelam, bromocriptine, and pramlintide.”

  • The paper relies on this without support.

    Studies in older individuals with diabetes are limited.

    “Studies in older individuals with diabetes are limited.”

  • The paper relies on this without support.

    The prevalence of any hypoglycemia or severe hypoglycemia in older populations is not known.

    “The prevalence of any hypoglycemia (measured blood glucose below 70 mg/dl) or severe hypoglycemia (requiring third party assistance) in older populations is not known.”

  • The paper relies on this without support.

    Un- or undertreated hyperglycemia also has risks, even in patients with life expectancy too short to be impacted by the development of chronic complications.

    “Although attention has rightly been paid to the risks of overtreatment of hyperglycemia in older adults (hypoglycemia, treatment burden, possibly increased mortality), un- or undertreated hyperglycemia also has risks, even in patients with life expectancy too short to be impacted by the development of chronic complications.”

  • The paper relies on this without support.

    Blood glucose levels consistently over the renal threshold for glycosuria (~180–200 mg/dl, but can vary) increase risk for dehydration, electrolyte abnormalities, urinary incontinence, dizziness, and falls.

    “Blood glucose levels consistently over the renal threshold for glycosuria (~180–200 mg/dl, but can vary) increase risk for dehydration, electrolyte abnormalities, urinary incontinence, dizziness, and falls.”

  • The paper relies on this without support.

    Hyperglycemic hyperosmolar syndrome (HHS) is a particularly severe complication of unrecognized or undertreated hyperglycemia in older adults.

    “Hyperglycemic hyperosmolar syndrome (HHS) is a particularly severe complication of unrecognized or undertreated hyperglycemia in older adults.”

  • The paper relies on this without support.

    A limitation of existing mortality models is that they can help us to rank patients by probability of death, but these probabilities must still be transformed into a life expectancy for a particular older diabetes patient.

    “A limitation of existing mortality models is that they can help us to rank patients by probability of death, but these probabilities must still be transformed into a life expectancy for a particular older diabetes patient.”

  • The paper relies on this without support.

    Simulation models can help transform mortality prediction into a useable life expectancy.

    “Simulation models can help transform mortality prediction into a useable life expectancy.”

  • The paper relies on this without support.

    In light of the paucity of data for diabetes care in older adults, treatment decisions are frequently made with considerable uncertainty.

    “In light of the paucity of data for diabetes care in older adults, treatment decisions are frequently made with considerable uncertainty.”

  • The paper relies on this without support.

    A key component of improving communication in the clinical setting may be finding congruence between patient goals and the biomedical goals on which clinicians tend to focus.

    “A key component of improving communication in the clinical setting may be finding congruence between patient goals and the biomedical goals on which clinicians tend to focus.”

  • The paper relies on this without support.

    Discussions eliciting and incorporating patients’ preferences regarding treatments and treatment targets may be difficult when patients do not understand the significance of risk factors or the value of risk reduction.

    “Discussions eliciting and incorporating patients’ preferences regarding treatments and treatment targets may be difficult when patients do not understand the significance of risk factors or the value of risk reduction.”

  • The paper relies on this without support.

    Many older adults rely on family members or friends to help them with their treatment decisions, or to implement day-to-day treatments.

    “Many older adults rely on family members or friends to help them with their treatment decisions, or to implement day-to-day treatments.”

  • The paper relies on this without support.

    In the case of the older person with cognitive deficits, the family member or friend may in fact be serving as a surrogate decision maker.

    “In the case of the older person with cognitive deficits, the family member or friend may in fact be serving as a surrogate decision maker.”

  • The paper relies on this without support.

    The LTC facility resident may have irregular and unpredictable meal consumption, undernutrition, anorexia, and impaired swallowing.

    “The LTC facility resident may have irregular and unpredictable meal consumption, undernutrition, anorexia, and impaired swallowing.”

  • The paper relies on this without support.

    Therapeutic diets may inadvertently lead to decreased food intake and contribute to unintentional weight loss and undernutrition.

    “Therapeutic diets may inadvertently lead to decreased food intake and contribute to unintentional weight loss and undernutrition.”

  • The paper relies on this without support.

    Vulnerable older adults, particularly those with cognitive dysfunction, may have impaired thirst sensation, contributing to risk of volume depletion and hyperglycemic crises.

    “Vulnerable older adults, particularly those with cognitive dysfunction, may have impaired thirst sensation, contributing to risk of volume depletion and hyperglycemic crises.”

  • The paper relies on this without support.

    Excessive reliance on sliding scale insulin (SSI) has been documented.

    “Excessive reliance on sliding scale insulin (SSI) has been documented.”

  • The paper relies on this without support.

    Evidence-based policies for glycemic control, use of insulin, and treatment of hypoglycemia have the potential to improve the care of residents with diabetes, alleviate some of the burden caused by frequent staff turnover, and even lead to more staff satisfaction.

    “Evidence-based policies for glycemic control, use of insulin, and treatment of hypoglycemia have the potential to improve the care of residents with diabetes, alleviate some of the burden caused by frequent staff turnover, and even lead to more staff satisfaction.”

  • The paper relies on this without support.

    Older adults are more apt to require hospitalization than younger adults, and those with diabetes are at very high risk of requiring hospitalization.

    “Older adults are more apt to require hospitalization than younger adults, and those with diabetes are at very high risk of requiring hospitalization.”

  • The paper relies on this without support.

    There is a dearth of studies addressing older adults with diabetes, particularly more frail older adults, in the hospital.

    “There is a dearth of studies addressing older adults with diabetes, particularly more frail older adults, in the hospital.”

  • The paper relies on this without support.

    Less stringent glycemic targets may be appropriate for patients with multiple co-morbidities and reduced life expectancy, criteria that could be applicable to many hospitalized older adults.

    “Less stringent glycemic targets may be appropriate for patients with multiple co-morbidities and reduced life expectancy, criteria that could be applicable to many hospitalized older adults.”

  • The paper relies on this without support.

    Transitions from hospital to home or to short- or long-term care facilities are times of risk for patients with diabetes, and probably more so for older patients.

    “Transitions from hospital to home or to short- or long-term care facilities are times of risk for patients with diabetes, and probably more so for older patients.”

  • The paper relies on this without support.

    Delirium is a common complication seen in older adults during and after hospitalization.

    “Delirium (acute decline in cognitive function) is a common complication seen in older adults during and after hospitalization and may require more supervision to avoid errors in dosing.”

  • The paper relies on this without support.

    The exclusion of older, and especially frail older, participants from most traditional randomized controlled trials of diabetes interventions has left large gaps in knowledge of how best to address diabetes in the age group with the highest prevalence rates.

    “The exclusion of older, and especially frail older, participants from most traditional randomized controlled trials of diabetes interventions has left us with large gaps in our knowledge of how best to address diabetes in the age group with the highest prevalence rates.”
64 of 64

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  • Life-expectancy model cites the wrong reference

    Minor

    The life-expectancy simulation model is cited as reference 113, but reference 113 is about patients' preferences in medical decisions. Reference 112 is the listed decision analysis on the expected benefits of intensive glucose control in older patients.

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Research works printed but not linked: 3

  1. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2011, Atlanta, 2011
  2. American Geriatrics Society, 2012, Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults, J Am Geriatr Soc, 2012, 616
  3. 2003 National Academies Press Washington DC Committee on Understanding Eliminating Racial Ethnic Disparities in Health Care Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (with CD)

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Metadata

Authors
Sue Kirkman, M., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S., Korytkowski, M. T., Munshi, M. N., Odegard, P. S., Pratley, R. E., & Swift, C. S.
Affiliations
  • Medical Affairs and Community Information American Diabetes Association Alexandria Virginia
  • Vanderbilt University (US)
  • Diabetes Center of Cape Cod Emerald Physicians Hyannis Massachusetts
  • University of Miami (US)
  • VA Puget Sound Health Care System (US)
  • University of Michigan (US)
  • University of Chicago (US)
  • University of Pittsburgh (US)
  • Joslin Diabetes Center (US)
  • University of Washington (US)
  • AdventHealth (US)
  • Kadlec Regional Medical Center (US)
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2012-10-25
Volume
60
Issue
12
Pages
2342-2356
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/jgs.12035
PMC
PMC4525769
OpenAlex
W2110840270
Semantic Scholar
4de9559e53371b7c701c9e8e36d3ed616eb57a84
Cited by
548
References
145
Citations by year
2026: 20 · 2025: 19 · 2024: 29 · 2023: 20 · 2022: 31 · 2021: 35 · 2020: 42 · 2019: 48 · 2018: 54 · 2017: 54 · 2016: 48 · 2015: 61 · 2014: 66 · 2013: 19 · 2012: 1
FWCI
37.73
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • John A. Hartford Foundation
  • Hartford Foundation for Public Giving
  • Eli Lilly and Company
  • Sanofi
  • Regeneron Pharmaceuticals
  • Novo Nordisk
  • National Institutes of Health (P60 DK20595, AG-024824)
  • National Institute on Aging (AG‐024824, P30AG024824)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P60DK20595, DK092949, R01DK081796, P60DK020595, P30DK092949, P30DK020572)
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 › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
diabetes mellitus, older adults, geriatric diabetes management, consensus recommendations
MeSH terms
Aged, Diabetes Mellitus, Humans, Hypoglycemic Agents, Diabetes Complications

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