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13. Older Adults: Standards of Care in Diabetes—2024

Open access
American Diabetes Association Professional Practice Committee, ElSayed, Nuha A., Aleppo, Grazia, Bannuru, Raveendhara R., Bruemmer, Dennis, Collins, Billy S., Ekhlaspour, Laya, Hilliard, Marisa E. +14 more·2024·Diabetes Care
DOI 10.2337/dc24-s013PMC PMC10725804
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Abstract

The American Diabetes Association (ADA) “Standards of 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, an interprofessional expert committee, 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 and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

AI snapshot

Written from the paper’s full text.

TL;DR

This ADA *Standards of Care in Diabetes—2024* section provides evidence-graded recommendations for managing diabetes in older adults, emphasizing comprehensive geriatric assessment, individualized glycemic goals, hypoglycemia avoidance, and treatment deintensification. It covers neurocognitive screening, CGM and advanced insulin delivery, lifestyle management, pharmacologic therapy, long-term care, and end-of-life care.

Key findings

  • Older adults with diabetes are highly heterogeneous; over one-quarter of people over age 65 have diabetes and one-half of older adults have prediabetes. The section recommends assessing medical, psychological, functional, and social domains and screening for geriatric syndromes and polypharmacy (Recommendations 13.1, 13.2).
  • Glycemic goals should be individualized: A1C <7.0–7.5% (<53–58 mmol/mol) for otherwise healthy older adults with intact function; A1C <8.0% (<64 mmol/mol) for those with intermediate/complex health; and avoidance of reliance on A1C for very complex/poor health, focusing instead on avoiding hypoglycemia and symptomatic hyperglycemia (Recommendations 13.8a–c).
  • CGM is recommended for older adults with type 1 diabetes to reduce hypoglycemia (13.5) and should be considered for older adults with type 2 diabetes on insulin (13.6). In the WISDM trial, CGM reduced time with glucose <70 mg/dL versus standard monitoring (adjusted treatment difference −1.9% [−27 min/day]; 95% CI −2.8% to −1.1% [−40 to −16 min/day]; P < 0.001), and time in range 70–180 mg/dL increased by 8% (95% CI 6.0–11.5).
  • Pharmacologic recommendations favor low-hypoglycemia-risk agents, avoidance of overtreatment, and deintensification/simplification of complex insulin plans when harms or burdens exceed benefits (13.14–13.16d). For older adults with type 2 diabetes and overweight/obesity who can safely exercise, intensive lifestyle intervention with modest weight loss (e.g., 5–7%) should be considered (13.13).

Methods

  • This is an ADA *Standards of Care* clinical practice guideline section, not a primary study; recommendations are updated annually by the interprofessional ADA Professional Practice Committee using an evidence-grading system, with details referred to the Introduction and Methodology.
  • The text synthesizes cited randomized trials, observational studies, meta-analyses, and prior guidelines; no original sample or dataset is analyzed in this section.
  • Main output is consensus recommendations with evidence grades (e.g., A, B, C, E) covering assessment, neurocognitive function, hypoglycemia, treatment goals, lifestyle, pharmacologic therapy, long-term care, and end-of-life care.

Limitations

  • The paper states there are few long-term studies in older adults demonstrating benefits of intensive glycemic, blood pressure, and lipid management; there is no global consensus on geriatric patient classification; CGM data in long-term care are limited; and there is no consensus for managing type 1 diabetes at the end of life.
  • The paper notes that age-stratified analyses of some drug trials were prespecified but not powered to detect differences, and that many advanced insulin delivery trials included relatively few older adults.
  • Evident from the text: this is a guideline based on expert consensus and evidence grading rather than a systematic review with original data, and some cited trials excluded older adults with low functional status (e.g., Look AHEAD excluded individuals with low functional status and required ability to perform a maximal exercise test).

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

Integrity signals

Registry

Crossref · 10.2337/dc24-s013

Cites

151 of 151 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

91 of 129 cited sources checked · 33 supported · 1 flagged · accuracy not yet measured

  • Premisecitation
    § Older Adults With Complications and Reduced Functionality

    Compared with the healthy class, the cardiovascular class has the highest risk of frailty and subsequent mortality.

    “Compared with the healthy class, the cardiovascular class has the highest risk of frailty and subsequent mortality.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [9] Laiteerapong, 2012, Classification of older adults who have diabetes by comorbid conditions, United States, 2005-2006, Prev Chronic Dis source

      The Results (Class characteristics; page not provided) identify class 1 as relatively healthy and report that class 3 had the highest 5-year death rate (33%, versus 9% for class 1). Class 3 also had more functional difficulty, but the paper does not measure frailty or establish that it had the highest risk of frailty. The reported death rate supports the mortality comparison, not a claim that frailty led to mortality. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [61] Leung, 2021, Reexamining the classification of older adults with diabetes by comorbidities and exploring relationships with frailty, disability, and 5-year mortality, J Gerontol A Biol Sci Med Sci source

      The Results report that the cardiovascular Class 3 had more frailty than the healthier Class 1 and the highest 5-year mortality. But Class 2—not Class 3—had the highest frailty prevalence (0.64 versus 0.29), so the claim that the cardiovascular class had the highest risk of both outcomes is contrary to the paper. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [66] Huang, 2023, Data-driven classification of health status of older adults with diabetes: the diabetes and aging study, J Am Geriatr Soc source
  • Premisecitation
    § NEUROCOGNITIVE FUNCTION

    Poor glycemic management is associated with a decline in cognitive function.

    “Poor glycemic management is associated with a decline in cognitive function (15,16), and longer duration of diabetes is associated with worsening cognitive function.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [15] Yaffe, 2012, Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia, Arch Neurol source
    • cites [16] Rawlings, 2014, Diabetes in midlife and cognitive change over 20 years: a cohort study, Ann Intern Med source
  • Premisecitation
    § Abstract

    These geriatric syndromes and polypharmacy may impact older adults' diabetes self-management abilities and quality of life if left unaddressed.

    “These conditions may impact older adults' diabetes self-management abilities and quality of life if left unaddressed (2,6,7).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [2] Centers for Disease Control and Prevention . National Diabetes Statistics Report, 2020: Estimates of Diabetes and its Burden in the United States. 2020. Accessed 13 October 2023. Available from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

      Not checked in the free run.

    • cites [6] Sudore, 2012, Symptom burden of adults with type 2 diabetes across the disease course: diabetes & aging study, J Gen Intern Med source

      The Background (page unavailable) links diabetes with impaired quality of life, and the Conclusions call for symptom palliation across the disease course. The paper does not establish that geriatric syndromes or polypharmacy impair older adults’ diabetes self-management abilities; the quality-of-life support is broader than the specific claim. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [7] Laiteerapong, 2011, Correlates of quality of life in older adults with diabetes: the diabetes & aging study, Diabetes Care source

      The Conclusions report that geriatric syndromes are associated with lower health-related quality of life in older adults with diabetes and recommend addressing them. The paper does not establish that polypharmacy affects quality of life or that either polypharmacy or the studied geriatric syndromes impairs diabetes self-management abilities. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Interpretationcitation
    § Older Adults With Complications and Reduced Functionality

    Based on concepts of competing mortality and time to benefit, some people in the complex or intermediate health category with shorter life expectancy will have less benefit from glucose lowering.

    “Based on concepts of competing mortality and time to benefit, some people in this category with shorter life expectancy will have less benefit from glucose lowering and should have less stringent glycemic goals (64).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [64] Huang, 2008, The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis, Ann Intern Med source
  • Premisecitation
    § 13.4

    Severe hypoglycemia has been linked to increased risk of dementia.

    “Cognitive decline has been associated with increased risk of hypoglycemia, and conversely, severe hypoglycemia has been linked to increased risk of dementia (30)(31)(32).”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [30] Feinkohl, 2014, Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study, Diabetes Care source
    • cites [31] Lee, 2018, Severe hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study, Diabetologia source
    • cites [32] Jacobson, 2021, Cognitive performance declines in older adults with type 1 diabetes: results from 32 years of follow-up in the DCCT and EDIC Study, Lancet Diabetes Endocrinol source

      The Results report that severe hypoglycemia was associated with declining psychomotor and mental efficiency in adults with type 1 diabetes, and the Discussion links it to clinically significant cognitive impairment. The paper does not report an increased risk of dementia, which is the more specific outcome in the claim. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • May combine two claims. 29
  • Classified as probably not a substantial claim. 8

  • May combine two claims.

    Premisecitation
    § NEUROCOGNITIVE FUNCTION

    People with diabetes have higher incidences of all-cause dementia, Alzheimer disease, and vascular dementia than people with normal glucose tolerance.

    “People with diabetes have higher incidences of all-cause dementia, Alzheimer disease, and vascular dementia than people with normal glucose tolerance (14).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Xu, 2009, Uncontrolled diabetes increases the risk of Alzheimer’s disease: a population-based cohort study, Diabetologia source

      The Results and Table 3 (page unavailable in our copy) compare participants with diabetes against a normal reference group and find an increased risk of vascular dementia for diabetes overall. Increased risks of all-cause dementia and Alzheimer’s disease appear for undiagnosed diabetes, not diabetes overall; the Abstract likewise states that overall diabetes was related only to vascular dementia. The claim omits that distinction. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § NEUROCOGNITIVE FUNCTION

    Older adults with diabetes are at higher risk of cognitive decline and institutionalization.

    “Older adults with diabetes are at higher risk of cognitive decline and institutionalization (12,13).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [12] Cukierman, 2005, Cognitive decline and dementia in diabetes–systematic overview of prospective observational studies, Diabetologia source

      The Discussion (p. 7) concludes that people with diabetes have a greater rate and risk of cognitive decline than people without diabetes; the Discussion (p. 8) notes that findings in older participants were consistent with this conclusion. Our copy does not report a higher risk of institutionalization (searched for institutionalization, institutionalisation, and related care settings), so that part is unsupported by this source. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [13] Roberts, 2014, Association of type 2 diabetes with brain atrophy and cognitive impairment, Neurology source

      The Abstract (page not provided) reports that midlife diabetes was associated with prevalent mild cognitive impairment in older participants, supporting the cognitive-impairment portion of the claim. It reports few cognitive effects of late-life-onset diabetes, and the paper does not address institutionalization. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Abstract

    The comprehensive assessment described provides a framework to determine goals and therapeutic approaches, including whether referral for diabetes self-management education is appropriate or whether the current plan is too complex for the individual's self-management ability or caregivers.

    “The comprehensive assessment described above provides a framework to determine goals and therapeutic approaches (8)(9)(10), including whether referral for diabetes self-management education is appropriate (when complicating factors arise or when transitions in care occur) or whether the current plan is too complex for the individual's self-management ability or the caregivers providing care (11).”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [8] McClintock, 2016, Empirical redefinition of comprehensive health and well-being in the older adults of the United States, Proc Natl Acad Sci USA source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [9] Laiteerapong, 2012, Classification of older adults who have diabetes by comorbid conditions, United States, 2005-2006, Prev Chronic Dis source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [10] Blaum, 2010, Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study, Med Care source

      The Discussion says that some middle-aged and older adults face diabetes self-management challenges and may need patient and caregiver education or other assistance. It does not describe a comprehensive assessment for deciding whether a care plan exceeds an individual’s or caregivers’ abilities, nor does it specify when to refer for diabetes self-management education. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Older Adults With Complications and Reduced Functionality

    The geriatric class has the highest prevalence of obesity, hypertension, arthritis, and incontinence, and the cardiovascular class has the highest prevalence of myocardial infarctions, heart failure, and stroke.

    “The geriatric class has the highest prevalence of obesity, hypertension, arthritis, and incontinence, and the cardiovascular class has the highest prevalence of myocardial infarctions, heart failure, and stroke.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [9] Laiteerapong, 2012, Classification of older adults who have diabetes by comorbid conditions, United States, 2005-2006, Prev Chronic Dis source

      The Results, under “Class characteristics” (page not provided), report that class 2 had the highest estimated probabilities of obesity, hypertension, and incontinence, while class 3 had the highest probabilities of myocardial infarction, congestive heart failure, and stroke. The exception is arthritis: the paper places its highest estimated probability in class 3, not class 2. (LLM, conf=0.91)

      Experimental — accuracy not yet measured
    • cites [61] Leung, 2021, Reexamining the classification of older adults with diabetes by comorbidities and exploring relationships with frailty, disability, and 5-year mortality, J Gerontol A Biol Sci Med Sci source

      The Results identify Class 2 as the geriatric-syndrome profile and Class 3 as the cardiovascular profile, with the stated conditions generally more prevalent in those classes. But the detailed Results report an exception: in 2005–2006, arthritis prevalence was higher in Class 3 (0.83) than in Class 2 (0.74), so Class 2 did not always have the highest arthritis prevalence. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [66] Huang, 2023, Data-driven classification of health status of older adults with diabetes: the diabetes and aging study, J Am Geriatr Soc source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § NEUROCOGNITIVE FUNCTION

    The U.S. Food and Drug Administration has approved two new anti-amyloid monoclonal antibodies for the treatment of early Alzheimer disease.

    “Recently, the U.S. Food and Drug Administration (FDA) has approved two new anti-amyloid monoclonal antibodies for the treatment of early Alzheimer disease (21).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [21] Leisher, 2023, Amyloid-lowering monoclonal antibodies for the treatment of early Alzheimer’s disease, CNS Drugs source

  • May combine two claims.

    Premisecitation
    § Use of Continuous Glucose Monitoring and Advanced Insulin Delivery Devices

    Among secondary outcomes in the WISDM trial, time spent in range between 70 and 180 mg/dL increased by 8% and glycemic variability decreased.

    “Among secondary outcomes, time spent in range between 70 and 180 mg/dL increased by 8% (95% CI 6.0-11.5)and glycemic variability (%CV) decreased.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [38] Carlson, 2021, Hypoglycemia and glycemic control in older adults with type 1 diabetes: baseline results from the WISDM study, J Diabetes Sci Technol source
    • cites [39] Pratley, 2020, Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial, JAMA source

      The Glycemic Control Outcomes section reports that time in the 70–180 mg/dL range was 8.8 percentage points higher with CGM than with standard blood glucose monitoring (95% CI, 6.0–11.5), not 8%. Table 2 also reports a lower coefficient of variation, supporting the claim about decreased glycemic variability. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § LIFESTYLE MANAGEMENT

    Look AHEAD benefits included weight loss, improved physical fitness, increased HDL cholesterol, lowered systolic blood pressure, reduced A1C levels, reduced waist circumference, and reduced need for medications.

    “Benefits included weight loss, improved physical fitness, increased HDL cholesterol, lowered systolic blood pressure, reduced A1C levels, reduced waist circumference, and reduced need for medications (80).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [80] Wing, 2013, Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes, N Engl J Med source

      The Results sections on Weight, Waist Circumference and Fitness and Cardiovascular Disease Risk Factors (page not provided) report greater weight loss, improved fitness and waist circumference, improvements in A1c and systolic blood pressure, and lower use of antihypertensive medications, statins and insulin in the intervention group. The latter supports lower medication use, though not a measured reduction in need. Our copy reports improvement in measured cardiovascular risk factors other than LDL cholesterol but does not specifically identify an increase in HDL cholesterol. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 13.8a

    Serum glycated protein assays (fructosamine and glycated albumin) may also be useful for glycemic monitoring in conjunction with other measures.

    “Serum gly- cated protein assays (fructosamine and glycated albumin) may also be useful for glycemic monitoring in conjunction with other measures (see Section 6, “Glycemic Goals and Hypoglycemia”) (56)(57)(58)(59)(60).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [56] Parrinello, 2014, Beyond HbA1c and glucose: the role of nontraditional glycemic markers in diabetes diagnosis, prognosis, and management, Curr Diab Rep source
    • cites [57] Selvin, 2014, Fructosamine and glycated albumin for risk stratification and prediction of incident diabetes and microvascular complications: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study, Lancet Diabetes Endocrinol source
    • cites [58] Nathan, 2014, Relationship of glycated albumin to blood glucose and HbA1c values and to retinopathy, nephropathy, and cardiovascular outcomes in the DCCT/EDIC study, Diabetes source

      The Results and Discussion (page unavailable) show that glycated albumin reflects glycemia and that combining it with HbA1c strengthened associations with microvascular complications, supporting its potential use alongside other measures. The paper mentions fructosamine in the Introduction but does not evaluate it as a monitoring assay, so it does not support that part of the claim. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § NEUROCOGNITIVE FUNCTION

    These anti-amyloid monoclonal antibodies lower the amyloid burden in the brain and appear to slow cognitive decline in the populations tested.

    “These drugs lower the amyloid burden in the brain and appear to slow cognitive decline in the populations tested.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [21] Leisher, 2023, Amyloid-lowering monoclonal antibodies for the treatment of early Alzheimer’s disease, CNS Drugs source

  • May combine two claims.

    Premisecitation
    § 13.8a

    The Life Expectancy Estimator for Older Adults with Diabetes (LEAD) tool was developed and validated among older adults with diabetes, and a high risk score was strongly associated with having a life expectancy of <5 years.

    “Notably, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD) tool was developed and validated among older adults with diabetes, and a high risk score was strongly associated with having a life expectancy of <5 years (52).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [52] Karter, 2023, Development and validation of the Life Expectancy Estimator for Older Adults with Diabetes (LEAD): the diabetes and aging study, J Gen Intern Med source

  • May combine two claims.

    Premisecitation
    § LIFESTYLE MANAGEMENT

    The benefits of a structured exercise program (as in the Lifestyle Interventions and Independence for Elders [LIFE] study) in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty.

    “The benefits of a structured exercise program (as in the Lifestyle Interventions and Independence for Elders [LIFE] study) in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty (76,77).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [76] Pahor, 2014, Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial, JAMA source

      The Results, under “Major mobility disability” (page not available), report fewer cases in the physical-activity group than in the health-education group. The Results also report increased moderate activity, but do not establish reduced sedentary time; the paper does not report a reduction in frailty. Participants were sedentary older adults with physical limitations, not a group identified in the paper as frail. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [77] Gill, 2002, A program to prevent functional decline in physically frail, elderly persons who live at home, N Engl J Med source

      The Results and Discussion (page unavailable) report less functional decline and lower disability scores after a home-based intervention, chiefly among participants with moderate frailty. Walking was one component of the disability scale, but the paper does not establish prevention of mobility disability specifically. It does not report reduced sedentary time or reduced frailty, and the intervention was not the LIFE study. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § 13.4

    Older adults are at higher risk of hypoglycemia for many reasons, including erratic meal intake, insulin deficiency necessitating insulin therapy, and progressive renal insufficiency.

    “Older adults are at higher risk of hypoglycemia for many reasons, including erratic meal intake, insulin deficiency necessitating insulin therapy, and progressive renal insufficiency (29).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [29] Lee, 2017, Risk factors for severe hypoglycemia in black and white adults with diabetes: the Atherosclerosis Risk in Communities (ARIC) study, Diabetes Care source

      The Abstract (page not provided) reports that older age and insulin use were associated with severe hypoglycemia. The Conclusions (page not provided) identify kidney disease as a risk factor. The paper does not identify erratic meal intake as a cause or say that age-related insulin deficiency necessitates insulin therapy; it studies severe hypoglycemia in adults with type 2 diabetes, rather than hypoglycemia generally. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § 13.8a

    Some older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty.

    “Some older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty (48,49).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [48] Bandeen-Roche, 2015, Frailty in older adults: a nationally representative profile in the United States, J Gerontol A Biol Sci Med Sci source

      The Results and Table 2 show that diabetes occurs among frail older adults, and the Results report multimorbidity, probable dementia, and functional limitations in the older population studied. The paper does not establish those latter findings specifically for adults with diabetes or identify diabetes-related comorbidity. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [49] Kalyani, 2012, Hyperglycemia and incidence of frailty and lower extremity mobility limitations in older women, J Am Geriatr Soc source

      The Introduction (page unavailable) links diabetes in older people to impaired physical functioning, lower-extremity mobility limitations, and frailty. The Discussion mentions cardiovascular disease and neuropathy, but the paper does not establish substantial diabetes-related comorbidity or address limited cognitive functioning. It therefore supports only part of the list attributed to it. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § LIFESTYLE MANAGEMENT

    Diabetes in the aging population is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass, which may result in sarcopenia and/or osteopenia.

    “Diabetes in the aging population is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass, which may result in sarcopenia and/or osteopenia (74,75).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [74] Park, 2007, Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study, Diabetes Care source

      The Results (p. 1) report greater losses of leg muscle mass, strength, and quality in older adults with type 2 diabetes. The discussion (p. 3) defines sarcopenia as decreased skeletal muscle mass, making it a plausible implication of the findings. The paper does not address osteopenia or show that these muscle changes result in it. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [75] Park, 2006, Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study, Diabetes source

      The Discussion (page unavailable) associates type 2 diabetes in community-dwelling older adults with lower muscle strength and quality. It does not establish accelerated loss of muscle mass: the study is cross-sectional and calls for prospective research on muscle-mass loss. The cited passages also do not link these findings to sarcopenia or osteopenia. (LLM, conf=0.91)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § LIFESTYLE MANAGEMENT

    While the Look AHEAD trial did not achieve its primary outcome of reducing cardiovascular events, the intensive lifestyle intervention had multiple clinical benefits that are important to the quality of life of older adults.

    “While the Look AHEAD trial did not achieve its primary outcome of reducing cardiovascular events, the intensive lifestyle intervention had multiple clinical benefits that are important to the quality of life of older adults.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [80] Wing, 2013, Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes, N Engl J Med source

  • May combine two claims.

    Premisecitation
    § 13.4

    Older adults can be stratified for future risk for hypoglycemia with validated risk calculators such as the Kaiser Hypoglycemia Model and with consideration of hypoglycemia risk factors.

    “Older adults can also be stratified for future risk for hypoglycemia with validated risk calculators (e.g., Kaiser Hypoglycemia Model) (34) and with consideration of hypoglycemia risk factors (Table 6.5).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [34] Karter, 2017, Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use, JAMA Intern Med source

      The Introduction and Model selection sections describe a validated tool that uses patient risk factors, including age, to stratify adults with type 2 diabetes by future hypoglycemia-related risk. The claim is broader than the outcome studied: the tool predicts hypoglycemia-related emergency department or hospital use over 12 months, not hypoglycemia events generally. The separate reference to risk factors in Table 6.5 is not attributed to this source. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Insulin Therapy

    Once-daily basal insulin injection therapy is associated with minimal side effects and may be a reasonable option in many older adults.

    “Once-daily basal insulin injection therapy is associated with minimal side effects and may be a reasonable option in many older adults (119).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [119] Bradley, 2021, Severe hypoglycemia risk with long-acting insulin analogs vs neutral protamine Hagedorn insulin, JAMA Intern Med source

      The Results and Discussion report a lower risk of severe hypoglycemia with long-acting insulin analogs than with NPH insulin in older adults with type 2 diabetes, although the association was not seen with concomitant prandial insulin. The paper does not establish that once-daily basal injections have minimal side effects overall or recommend them as a reasonable option for many older adults. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § END-OF-LIFE CARE

    The evidence for the safety and efficacy of deintensification protocols in older adults is growing for both glucose and blood pressure management and is clearly relevant for palliative care.

    “The evidence for the safety and efficacy of deintensification protocols in older adults is growing for both glucose and blood pressure management (97,134) and is clearly relevant for palliative care.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [97] McAlister, 2017, Treatment deintensification is uncommon in adults with type 2 diabetes mellitus: a retrospective cohort study, Circ Cardiovasc Qual Outcomes source

      The Discussion reports that glycemic therapy was rarely reduced even in frail patients or those with multiple comorbidities, and describes harms of intensive glucose control. This supports a rationale for glucose-treatment deintensification, but the paper measures deintensification rates rather than the safety or efficacy of deintensification protocols. It does not study blood-pressure deintensification; that topic appears in a cited reference. The palliative-care relevance is the citing authors’ own conclusion. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [134] Sheppard, 2020, Effect of antihypertensive medication reduction vs usual care on short-term blood pressure control in patients with hypertension aged 80 years and older: the OPTIMISE randomized clinical trial, JAMA source

      The Primary Outcome section reports that antihypertensive medication reduction was noninferior to usual care for blood-pressure control at 12 weeks, supporting the blood-pressure part of the claim. The Discussion says the trial was not powered to detect differences in adverse effects, and the Subgroup Analyses report more adverse events in the reduction group; this paper therefore does not establish safety. The separate glucose-management citation and the citing authors’ palliative-care framing are not assessed here. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Incretin-Based Therapies

    In phase 3 trials, tirzepatide decreased A1C and weight generally to a greater extent than other glucose-lowering drugs including semaglutide and insulin, with no significant differences in safety or efficacy in older compared with younger individuals.

    “In phase 3 trials, tirzepatide decreased A1C and weight-generally to a greater extent than other glucose-lowering drugs including semaglutide and insulinwith no significant differences in the safety or efficacy in older compared with younger individuals (115).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [115] Kushner, 2023, Efficacy and safety of tirzepatide in adults with type 2 diabetes: a perspective for primary care providers, Clin Diabetes source

      Split into 2 atoms — 1 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Resources

    Special management considerations include the need to avoid both hypoglycemia and the complications of hyperglycemia.

    “Special management considerations include the need to avoid both hypoglycemia and the complications of hyperglycemia (2,126).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [2] Centers for Disease Control and Prevention . National Diabetes Statistics Report, 2020: Estimates of Diabetes and its Burden in the United States. 2020. Accessed 13 October 2023. Available from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

      Not checked in the free run.

    • cites [126] Sinclair, 2012, Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes, J Am Med Dir Assoc source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § SPECIAL CONSIDERATIONS FOR OLDER ADULTS WITH TYPE 1 DIABETES

    Due in part to the success of modern diabetes management, people with type 1 diabetes are living longer, and the population over 65 years of age is growing.

    “Due in part to the success of modern diabetes management, people with type 1 diabetes are living longer, and the population of these people over 65 years of age is growing (121-123).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [121] Livingstone, 2015, Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010, JAMA source

      The Discussion reports greater life expectancy in this Scottish cohort than in earlier cohorts, but says the populations may not be comparable and that the study cannot directly assess improvement over time. It does not establish that modern diabetes management caused longer lives or that the population with type 1 diabetes over age 65 is growing. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [122] Miller, 2012, Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort, Diabetes source

      The Discussion (page unavailable) reports substantially improved life expectancy in the more recent childhood-onset type 1 diabetes cohort and identifies better treatment, glucose monitoring, and insulin administration as possible contributors. It does not report that the population with type 1 diabetes over age 65 is growing. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [123] Bullard, 2018, Prevalence of diagnosed diabetes in adults by diabetes type – United States, 2016, MMWR Morb Mortal Wkly Rep source

      The paper’s Discussion reports a 2016 estimate of adults with type 1 diabetes and says it is unknown whether a reported prevalence trend differs for type 1 diabetes. Its age-group results are cross-sectional. Our copy does not establish that modern management has extended survival or that the population with type 1 diabetes aged 65 or older is growing (searched: survival, older adults, age 65, and population trends). (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    Older adults with diabetes have higher rates of functional disability, accelerated muscle loss, coexisting illnesses such as hypertension, chronic kidney disease, coronary heart disease, and stroke, and premature death than those without diabetes.

    “Older adults with diabetes have higher rates of functional disability, accelerated muscle loss, and coexisting illnesses, such as hypertension, chronic kidney disease, coronary heart disease, and stroke, and of premature death than those without diabetes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Laiteerapong N , HuangES. Diabetes in older adults. In Diabetes in America. 3rd ed.CowieCC, CasagrandeSS, MenkeA, ., Eds. Bethesda, MD, National Institute of Diabetes and Digestive and Kidney Diseases (US), 2018. Accessed 13 October 2023. Available from https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/diabetes-in-america-3rd-edition

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Abstract

    Older adults with diabetes require greater caregiver support and are at greater risk than other older adults for common geriatric syndromes such as cognitive impairment, depression, urinary incontinence, injurious falls, persistent pain, frailty, and polypharmacy.

    “also require greater caregiver support and are at greater risk than other older adults for several common geriatric syndromes such as cognitive impairment, depression, urinary incontinence, injurious falls, persistent pain, and frailty as well as polypharmacy (1).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Laiteerapong N , HuangES. Diabetes in older adults. In Diabetes in America. 3rd ed.CowieCC, CasagrandeSS, MenkeA, ., Eds. Bethesda, MD, National Institute of Diabetes and Digestive and Kidney Diseases (US), 2018. Accessed 13 October 2023. Available from https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/diabetes-in-america-3rd-edition

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § 13.8a

    Many conditions associated with increased red blood cell turnover, such as hemodialysis, recent blood loss or transfusion, or erythropoietin therapy, are commonly seen in older adults and can falsely increase or decrease A1C.

    “Many conditions associated with increased red blood cell turnover, such as hemodialysis, recent blood loss or transfusion, or erythropoietin therapy, are commonly seen in older adults and can falsely increase or decrease A1C.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] National Glycohemoglobin Standardization Program . Factors that interfere with HbA1c test results. Accessed 13 October 2023. Available from https://ngsp.org/factors.asp

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § NEUROCOGNITIVE FUNCTION

    Cognitive impairment and its associated self-care difficulties increase risk for hypoglycemia, which in turn can worsen cognitive function.

    “These factors increase risk for hypoglycemia, which, in turn, can worsen cognitive function.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given
    § 13.8a

    Older adults with diabetes and intermediate or complex health are clinically heterogeneous with variable life expectancy.

    “Older adults with diabetes and intermediate or complex health are clinically heterogeneous with variable life expectancy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § 13.4

    Older adults have higher rates of unidentified cognitive impairment and dementia, leading to difficulties in adhering to complex self-care activities such as glucose monitoring and insulin dose adjustment.

    “As described above, older adults have higher rates of unidentified cognitive impairment and dementia, leading to difficulties in adhering to complex self-care activities (e.g., glucose monitoring and insulin dose adjustment).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Hypoglycemia

    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).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [128] Migdal, 2011, Update on diabetes in the elderly and in nursing home residents, J Am Med Dir Assoc source

  • May combine two claims.

    Premisecitation
    § SPECIAL CONSIDERATIONS FOR OLDER ADULTS WITH TYPE 1 DIABETES

    CGM is approved for use by Medicare and can play a critical role in improving A1C, reducing glycemic variability, and reducing risk of hypoglycemia.

    “CGM is approved for use by Medicare and can play a critical role in improving A1C, reducing glycemic variability, and reducing risk of hypoglycemia (43)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Ruedy, 2017, Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial, J Diabetes Sci Technol source

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation
    § SPECIAL CONSIDERATIONS FOR OLDER ADULTS WITH TYPE 1 DIABETES

    Many recommendations regarding comprehensive geriatric assessment and personalization of goals and treatments are directly applicable to older adults with type 1 diabetes, but this population has unique challenges and requires distinct treatment considerations.

    “Many of the recommendations in this section regarding a comprehensive geriatric assessment and personalization of goals and treatments are directly applicable to older adults with type 1 diabetes; however, this population has unique challenges and requires distinct treatment considerations (124).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [124] Heise, 2004, Lower within-subject variability of insulin detemir in comparison to NPH insulin and insulin glargine in people with type 1 diabetes, Diabetes source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § END-OF-LIFE CARE

    Different categories have been proposed for diabetes management in those with advanced disease.

    “Different categories have been proposed for diabetes management in those with advanced disease (68).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Sinclair, 2013

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Other Factors to Consider

    Transitions to acute care and long-term care can lead to discontinuity in goals of care, errors in dosing, and changes in nutrition and activity.

    “Unfortunately, these transitions can lead to discontinuity in goals of care, errors in dosing, and changes in nutrition and activity (120).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [120] Pandya, 2020, Challenges and strategies for managing diabetes in the elderly in long-term care settings, Diabetes Spectr source
32 of 32

  • The paper relies on this without support.

    Cardiovascular risk factors are associated with an increased risk of cognitive decline and dementia.

    “Cardiovascular risk factors are also associated with an increased risk of cognitive decline and dementia.”

  • The paper relies on this without support.

    Control of blood pressure and cholesterol lowering with statins reduce the risk of incident dementia.

    “Control of blood pressure and cholesterol lowering with statins have been associated with a reduced risk of incident dementia and are, thus, particularly important in older adults with diabetes.”

  • The paper relies on this without support.

    Advanced insulin delivery devices improve glycemic outcomes in both children and adults with type 1 diabetes.

    “Advanced insulin delivery devices have been shown to improve glycemic outcomes in both children and adults with type 1 diabetes.”

  • The paper relies on this without support.

    Most trials of advanced insulin delivery devices have included relatively few older adults.

    “Most trials of these devices have included a broad range of people with type 1 diabetes but relatively few older adults.”

  • The paper relies on this without support.

    Life expectancies are highly variable but are often longer than clinicians realize.

    “Life expectancies are highly variable but are often longer than clinicians realize.”

  • The paper relies on this without support.

    Many older adults with diabetes struggle to maintain frequent blood glucose monitoring and insulin injection plans as they develop medical conditions that may impair their ability to follow their treatment plan safely.

    “Many older adults with diabetes struggle to maintain the frequent blood glucose monitoring and insulin injection plans they previously followed, perhaps for many decades, as they develop medical conditions that may impair their ability to follow their treatment plan safely.”

  • The paper relies on this without support.

    Metformin is contraindicated in individuals with advanced renal insufficiency and should be used with caution in those with impaired hepatic function or heart failure because of increased risk of lactic acidosis.

    “However, it is contraindicated in those with advanced renal insufficiency and should be used with caution in those with impaired hepatic function or heart failure because of the increased risk of lactic acidosis.”

  • The paper relies on this without support.

    Metformin daily can cause gastrointestinal side effects and a reduction in appetite that can be problematic for some older adults.

    “daily can cause gastrointestinal side effects and a reduction in appetite that can be problematic for some older adults.”

  • The paper relies on this without support.

    Sulfonylureas and other insulin secretagogues such as meglitinides are associated with hypoglycemia.

    “Sulfonylureas and other insulin secretagogues such as the meglitinides (repaglinide and nateglinide) are associated with hypoglycemia and should be used with caution.”

  • The paper relies on this without support.

    Oral DPP-4 inhibitors have few side effects and minimal risk of hypoglycemia.

    “Oral dipeptidyl peptidase 4 (DPP-4) inhibitors have few side effects and minimal risk of hypoglycemia, but their cost may be a barrier to some older adults.”

  • The paper relies on this without support.

    GLP-1 receptor agonists may be associated with nausea, vomiting, and diarrhea.

    “GLP-1 receptor agonists may also be associated with nausea, vomiting, and diarrhea.”

  • The paper relies on this without support.

    Side effects such as volume depletion, urinary tract infections, and worsening urinary incontinence may be more common among older people.

    “side effects such as volume depletion, urinary tract infections, and worsening urinary incontinence may be more common among older people”

  • The paper relies on this without support.

    Multiple daily injections of insulin may be too complex for an older person with advanced diabetes complications, life-limiting coexisting chronic illnesses, or limited functional status.

    “Multiple daily injections of insulin may be too complex for an older person with advanced diabetes complications, life-limiting coexisting chronic illnesses, or limited functional status.”

  • The paper relies on this without support.

    Insulin is an essential life-preserving therapy for people with type 1 diabetes, unlike for those with type 2 diabetes.

    “Insulin is an essential life-preserving therapy for people with type 1 diabetes, unlike for those with type 2 diabetes.”

  • The paper relies on this without support.

    To avoid diabetic ketoacidosis, older adults with type 1 diabetes need some form of basal insulin even when they are unable to ingest meals.

    “To avoid diabetic ketoacidosis, older adults with type 1 diabetes need some form of basal insulin even when they are unable to ingest meals.”

  • The paper relies on this without support.

    Older adults with diabetes in LTC are especially vulnerable to hypoglycemia.

    “Older adults with diabetes in LTC are especially vulnerable to hypoglycemia.”

  • The paper relies on this without support.

    An older adult residing in an LTC facility may have irregular and unpredictable meal consumption, undernutrition, anorexia, and impaired swallowing.

    “An older adult residing in an LTC facility 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.

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

  • The paper relies on this without support.

    In people with type 1 diabetes at the end of life, a small amount of basal insulin may maintain glucose levels and prevent acute hyperglycemic complications.

    “In people with type 1 diabetes, there is no consensus, but a small amount of basal insulin may maintain glucose levels and prevent acute hyperglycemic complications.”
19 of 19

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cited works that were retracted

Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.

  • Cites a retracted work: 10.1016/s0140-6736(20)30367-6

    Major

    The cited work was retracted on 2023-05-01 (notice 10.1016/s2468-2667(23)00083-x), before this paper was published (2023-12-11). Its authors could have known.

    Cited work 10.1016/s0140-6736(20)30367-6 · retracted 2023-05-01 · notice 10.1016/s2468-2667(23)00083-x · this paper published 2023-12-11

1 of 1

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 1

  1. Sinclair, 2013, International Diabetes Federation (IDF) Global Guideline for Managing Older People with Type 2 Diabetes

Cited by

Sorted by citations

Related

Authors
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Hilliard, M. E., Johnson, E. L., Khunti, K., Lingvay, I., Matfin, G., McCoy, R. G., Perry, M. L., Pilla, S. J., Polsky, S., Prahalad, P., Pratley, R. E., Segal, A. R., Seley, J. J., Stanton, R. C., & Gabbay, R. A.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2023-12-11
Volume
47
Issue
Supplement_1
Pages
S244-S257
ISSN
0149-5992 (ISSN-L)
DOI
10.2337/dc24-s013
PMC
PMC10725804
OpenAlex
W4389560727
Semantic Scholar
324081d7cf6a210392cc25acf8b68fe87febe972
Cited by
161
References
139
Citations by year
2026: 39 · 2025: 63 · 2024: 59
FWCI
5.85
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK121942)
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, diabetes management, clinical guidelines, treatment goals, quality of care, American Diabetes Association standards of care
MeSH terms
Aged, Diabetes Mellitus, Endocrinology, Humans, Reference Standards, Societies, Medical, Standard of Care

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-27.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-27.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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