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13. Older Adults: Standards of Medical Care in Diabetes—2022

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American Diabetes Association Professional Practice Committee·2022·Diabetes Care
DOI 10.2337/dc22-s013PMC PMC8935395
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Abstract

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Crossref · 10.2337/dc22-s013

Cites

113 of 113 references verified0 citation errors · 0 not checkable

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  • The mean HbA1c, GMI, TIR, and TBR results (8.0%, 7.6%, 56%, and 1.0% at 6 months, respectively) demonstrate close adherence to established glycemic targets.

    “Considering the older age of participants and comorbid conditions reported, the mean HbA1c, GMI, TIR, and TBR results (8.0%, 7.6%, 56%, and 1.0% at 6 months, respectively) demonstrate close adherence to established glycemic targets (23, 24, 38).”

    From Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis (2025) · cites this paper as [23]

    The Treatment Goals recommendations (section 13.3, page unavailable) set an individualized A1C goal of less than 8.0% for older adults with multiple coexisting conditions, so the reported mean of 8.0% is close to that target. The cited paper does not establish corresponding GMI, TIR, or TBR targets that would support describing all four results as close to established targets. The six-month results are the citing authors’ data, not results attributed to this source. (LLM, conf=0.85)

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  • Low and very low glucose events occurred at a low rate (mean of ∼1.3 and 0.2 events per person per week in the sixth month, respectively) and were in keeping with time below range meeting established standards.

    “Low and very low glucose events occurred at a low rate (mean of ∼1.3 and 0.2 events per person per week in the sixth month, respectively) and were in keeping with time below range meeting established standards (23, 24, 38).”

    From Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis (2025) · cites this paper as [23]

    The Hypoglycemia section gives a threshold for low glucose, and section 13.3 reports time spent below 70 mg/dL in a separate six-month CGM trial. Neither passage gives the claimed sixth-month event rates or a time-below-range standard against which to assess them. I searched for those rates and for time-below-range targets in our copy. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

  • Mean percent time of sensor use and mean coefficient of variation (84% and 31% at 6 months, respectively) are within established guidelines.

    “Other parameters such as the mean percent time of sensor use and mean coefficient of variation (84% and 31% at 6 months, respectively) are also within established guidelines (23, 24, 38).”

    From Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis (2025) · cites this paper as [23]

    The section on continuous glucose monitoring (13.3 Screening for early detection; page unavailable) reports a six-month trial and reduced glycemic variability, but gives no guideline threshold for sensor use or coefficient of variation. Searches for the 84% and 31% figures and for those metrics’ guidelines found no passage establishing that they are within guidelines. (LLM, conf=0.73)

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  • The observed reduction in HbA1c did not compromise the population from meeting established hypoglycemia targets of <4% and <1% for percent time <70 mg/dL (mean 1.0%) and <54 mg/dL (mean 0.04%), respectively.

    “The observed reduction in HbA1c did not compromise the population from meeting established hypoglycemia targets of < 4% and < 1% for percent time < 70 mg/dL (mean 1.0%) and < 54 mg/dL (mean 0.04%), respectively (22-24).”

    From Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis (2025) · cites this paper as [23]

    The Hypoglycemia and 13.3 sections discuss reducing hypoglycemia risk and report a separate trial’s time below 70 mg/dL. They do not state the <4% and <1% time-below-range targets or report the citing population’s means of 1.0% and 0.04%. I searched for those targets and for time below 70 and 54 mg/dL. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Cites

Flagged first, then by citations

3 of the 116 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. Cowie CC, Casagrande SS, Menke A, et al., Eds. Bethesda, MD, National Institute of Diabetes and Digestive and Kidney Diseases (US), 2018. PMID: 33651542
  2. Laiteerapong N, Iveniuk J, John PM, Laumann EO, Huang ES. Classification of older adults who have diabetes by comorbid conditions, United States, 2005-2006. Prev Chronic Dis 2012;9:E100
  3. Ghezzi L, Scarpini E, Galimberti D. Disease- modifying drugs in Alzheimer's disease. Drug Des Devel Ther 2013;7:1471-1478
  4. Tomlin A, Sinclair A. The influence of cognition on self-management of type 2 diabetes in older people. Psychol Res Behav Manag 2016;9:7-20
  5. Zhang JX, Bhaumik D, Huang ES, Meltzer DO. Change in insurance status and cost-related medication non-adherence among older U.S. adults with diabetes from 2010 to 2014. J Health Med Econ 2018;4:7

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Authors
American Diabetes Association Professional Practice Committee
Corresponding author
American Diabetes Association Professional Practice Committee
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2021-12-16
Volume
45
Issue
Supplement_1
Pages
S195-S207
ISSN
0149-5992 (ISSN-L)
DOI
10.2337/dc22-s013
PMC
PMC8935395
OpenAlex
W4200063208
Cited by
381
References
116
Citations by year
2026: 13 · 2025: 34 · 2024: 68 · 2023: 115 · 2022: 86 · 2021: 26 · 2020: 23 · 2019: 13 · 2018: 2 · 2013: 1
FWCI
11.31
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute on Aging (K24AG069080, R01AG060756, R01AG063391)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092949)
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 › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
diabetes in older adults, clinical guidelines, treatment goals, quality of care, level of evidence
MeSH terms
Aged, Diabetes Mellitus, Endocrinology, Humans, Reference Standards, Societies, Medical, Standard of Care

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