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13. Older Adults: Standards of Care in Diabetes—2025

Open access
American Diabetes Association Professional Practice Committee, ElSayed, Nuha A., McCoy, Rozalina G., Aleppo, Grazia, Balapattabi, Kirthikaa, Beverly, Elizabeth A., Briggs Early, Kathaleen, Bruemmer, Dennis +16 more·2025·Diabetes Care
DOI 10.2337/dc25-s013PMC PMC11635042
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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 section provides evidence-graded recommendations for managing diabetes in older adults, emphasizing comprehensive geriatric assessment, individualized glycemic goals, avoidance of hypoglycemia, and deintensification when treatment burdens outweigh benefits. It synthesizes trials and guidelines on CGM, insulin delivery, pharmacologic therapy, lifestyle, long-term care, and end-of-life care.

Key findings

  • Older adults with diabetes are highly heterogeneous; over 29% of people over age 65 have diabetes, and care should assess medical, psychological, functional, and social domains and screen at least annually for geriatric syndromes, hypoglycemia, and polypharmacy.
  • Glycemic goals are stratified: healthy older adults may target A1C <7.0–7.5% and/or TIR 70–180 mg/dL ≥70% with time below range <70 mg/dL <4%; intermediate/complex health may target A1C <8.0% and/or TIR ≥50% with time below range <1%; very complex/poor health should avoid reliance on A1C and focus on avoiding hypoglycemia and symptomatic hyperglycemia.
  • CGM evidence includes the WISDM trial in adults over 60 with type 1 diabetes, where CGM reduced time with glucose <70 mg/dL by an adjusted treatment difference of −1.9% (−27 min/day; 95% CI −2.8% to −1.1%; P < 0.001) and increased TIR by 8%; in the MOBILE analysis, older adults with type 2 diabetes on basal insulin had greater A1C reduction than younger adults (−0.65% vs. −0.35%) and greater TIR increase (19% vs. 12%, P = 0.01).
  • Pharmacologic and lifestyle recommendations include selecting low-hypoglycemia-risk agents, deintensifying/simplifying treatment, using metformin if eGFR ≥30 mL/min/1.73 m², considering intensive lifestyle intervention with 5–7% weight loss for nonfrail older adults with overweight/obesity, and noting a statin time to benefit of 2.5 years.

Methods

  • This is the American Diabetes Association “Standards of Care in Diabetes—2025,” Section 13, developed by the ADA Professional Practice Committee, an interprofessional expert committee that updates the Standards annually or more frequently as warranted.
  • The evidence-grading system and full methodology are described in the Introduction and Methodology; recommendations are graded (e.g., A, B, C, E).
  • It is not a primary study but a narrative synthesis of clinical trials, meta-analyses, observational data, and expert consensus to produce clinical practice recommendations.

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 classification; evidence for CGM in long-term care is limited; and most advanced insulin delivery trials included relatively few older adults.
  • The paper states there is no consensus for type 1 diabetes management at the end of life, and the evidence base for CGM in older adults is primarily in type 1 diabetes, though evidence in type 2 diabetes is growing.
  • Evident from the text: as a guideline, many recommendations rely on expert consensus and indirect evidence for older-adult subgroups, and some age-stratified analyses were not powered to detect differences.

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

Integrity signals

Registry

Crossref · 10.2337/dc25-s013

Cites

164 of 164 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

84 of 135 cited sources checked · 20 supported · 0 flagged · accuracy not yet measured

  • Premisecitation
    § 13.1

    These conditions 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 paperNot a substantial claim2 of 3 sources checked
    • cites [2] Centers for Disease Control and Prevention . National Diabetes Statistics Report. 2024. Accessed 31 August 2024. Available from https://www.cdc.gov/diabetes/php/data-research/index.html

      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 links diabetes with impaired quality of life, and the Discussion recommends addressing symptoms to maximize quality of life. The paper does not establish that these conditions affect older adults’ diabetes self-management abilities. (LLM, conf=0.85)

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    • 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, diabetes complications, and hypoglycemia are associated with lower health-related quality of life in older adults with diabetes, and recommend addressing these conditions. The paper does not establish that leaving them unaddressed impairs diabetes self-management abilities; its outcome was quality of life, and the study was cross-sectional. (LLM, conf=0.87)

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

    A recent randomized controlled trial of older adults with type 2 diabetes using multiple daily injections who were unable to manage insulin therapy on their own revealed an increase of time in range of 27% over 12 weeks of AID use in addition to tailored home health care services.

    “A recent randomized controlled trial of older adults with type 2 diabetes using multiple daily injections who were unable to manage insulin therapy on their own revealed an increase of TIR of 27% over 12 weeks of AID use in addition to tailored home health care services (49).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [49] Reznik, 2024, Should people with type 2 diabetes treated by multiple daily insulin injections with home health care support be switched to hybrid closed-loop? The CLOSE AP+ randomized controlled trial, Diabetes Obes Metab source
  • Premisecitation
    § Older Adults With Complications and Reduced Functionality

    Individuals with advanced diabetes complications, life-limiting comorbid illnesses, frailty, or substantial cognitive or functional impairments are more likely to experience serious adverse effects of therapeutics, such as hypoglycemia.

    “These individuals are also more likely to experience serious adverse effects of therapeutics, such as hypoglycemia (67).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [67] Huang, 2014, Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study, JAMA Intern Med source

      The Discussion (page not specified) says functional limitations are likely determinants of hypoglycemia risk and that insulin, sulfonylureas, and intensive treatment may increase that risk. It does not establish increased therapeutic-adverse-effect risk specifically for people with advanced diabetes complications, life-limiting comorbid illness, frailty, or cognitive impairment. (LLM, conf=0.84)

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  • Premisecitation
    § Beyond Glycemic Management

    A meta-analysis of statin trials showed that the time to benefit is 2.5 years.

    “For statins, a meta-analysis of the previously mentioned trials showed that the time to benefit is 2.5 years (75).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [75] Yourman, 2021, Evaluation of time to benefit of statins for the primary prevention of cardiovascular events in adults aged 50 to 75 years: a meta-analysis, JAMA Intern Med source

      The Key Points and Discussion report a 2.5-year time to benefit, but specifically for preventing one major adverse cardiovascular event per 100 adults aged 50–75 treated with statins for primary prevention. The citing sentence presents 2.5 years as a general time to benefit for statins without that outcome, treatment threshold, or population. (LLM, conf=0.84)

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  • Premisecitation
    § LIFESTYLE MANAGEMENT

    Malnutrition is associated with decreases in activities of daily living, grip strength, physical performance of lower limbs, cognition, and quality of life.

    “Malnutrition is also associated with decreases in activities of daily living, grip strength, physical performance of lower limbs, cognition, and quality of life (81-83).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [81] Liu, 2017, Pilot study of the Mini Nutritional Assessment on predicting outcomes in older adults with type 2 diabetes, Geriatr Gerontol Int source
    • cites [82] Malara, 2014, Relationship between cognitive impairment and nutritional assessment on functional status in Calabrian long-term-care, Clin Interv Aging source

      The Discussion (page not provided) links malnutrition with greater ADL impairment, and the Results (page not provided) report an association between nutritional status and cognitive performance. The Introduction (page not provided) says malnutrition can reduce health-related quality of life. Our copy does not establish the claimed associations with grip strength or lower-limb physical performance. (LLM, conf=0.88)

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    • cites [83] Alfonso-Rosa, 2013, The relationship between nutritional status, functional capacity, and health-related quality of life in older adults with type 2 diabetes: a pilot explanatory study, J Nutr Health Aging source

      The Results (Table 3; page unavailable) associate poorer nutritional status with lower-limb strength, quality of life, and reported problems with personal care and daily tasks in older adults with type 2 diabetes. They do not show an association with grip strength, and the paper does not report a nutritional-status association with cognition. The claim also omits the study’s specific population. (LLM, conf=0.87)

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    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 (13,14).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [13] Xue, 2019, Diabetes mellitus and risks of cognitive impairment and dementia: a systematic review and meta-analysis of 144 prospective studies, Ageing Res Rev source
    • cites [14] Roberts, 2014, Association of type 2 diabetes with brain atrophy and cognitive impairment, Neurology source

      The Results and Discussion (indexed under “Statistical analyses”; page unavailable) associate midlife diabetes with poorer cognition and elevated risk of mild cognitive impairment in older adults. The paper reports fewer cognitive effects for late-life-onset diabetes and does not address institutionalization. (LLM, conf=0.88)

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    Premisecitation
    § NEUROCOGNITIVE FUNCTION

    People with diabetes have higher incidences of all-cause dementia, Alzheimer disease, and vascular dementia than people without diabetes.

    “People with diabetes have higher incidences of all-cause dementia, Alzheimer disease, and vascular dementia than people without diabetes (15).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] Xu, 2009, Uncontrolled diabetes increases the risk of Alzheimer's disease: a population-based cohort study, Diabetologia source

      The Results (page not provided) report increased vascular dementia risk for the overall diabetes group, but not increased risk of all-cause dementia or Alzheimer disease for that group. Increased risks for all three outcomes were reported for the subgroup with undiagnosed diabetes, so the citing sentence overgeneralizes the finding to all people with diabetes. (LLM, conf=0.90)

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    Premisecitation
    § NEUROCOGNITIVE FUNCTION

    Diabetes-related dementia is characterized by slower progression of dementia, absence of typical neuroimaging findings, advanced age, elevated A1C levels, long duration of diabetes, high frequency of insulin use, frailty, sarcopenia, and dynapenia.

    “Diabetes-related dementia is characterized by a slower progression of dementia, absence of typical neuroimaging findings, advanced age, elevated A1C levels, long duration of diabetes, high frequency of insulin use, frailty, sarcopenia, and dynapenia (loss of muscle strength not caused by neurologic or muscular diseases) (18).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [18] Huang, 2022, Association between hypoglycemia and dementia in patients with diabetes: a systematic review and meta-analysis of 1.4 million patients, Diabetol Metab Syndr source

      The Discussion reports that high HbA1c is associated with increased dementia risk in people with diabetes, supporting the elevated-A1C element. It does not describe diabetes-related dementia as a syndrome with slower progression, absent typical neuroimaging findings, advanced age, long diabetes duration, frequent insulin use, frailty, sarcopenia, or dynapenia; its focus is hypoglycemia and dementia risk. (LLM, conf=0.82)

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    Interpretationcitation
    § TREATMENT GOALS

    These data may be a useful starting point to inform decisions about selecting less stringent glycemic goals.

    “These data may be a useful starting point to inform decisions about selecting less stringent glycemic goals (56,57).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [56] 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
    • cites [57] Deardorff, 2023, Incorporating prognosis into clinical decision-making for older adults with diabetes, J Gen Intern Med source

  • May combine two claims.

    Premisecitation
    § 13.4

    Older adults may be at higher risk of hypoglycemia for many reasons, including irregular meal intake, insulin deficiency necessitating insulin therapy, and worsening kidney function.

    “Older adults may be at higher risk of hypoglycemia for many reasons, including irregular meal intake, insulin deficiency necessitating insulin therapy, and worsening kidney function (32).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [32] 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 paper says severe hypoglycemia is more common after age 60 and, in the Conclusions (page unavailable), identifies kidney disease as a risk factor. It also links difficulty with eating or preparing meals to hypoglycemia risk, but does not establish irregular meal intake specifically. Although it discusses insulin use in older adults, our copy does not say that insulin deficiency necessitating insulin therapy explains their higher risk. (LLM, conf=0.88)

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    Premisecitation
    § LIFESTYLE MANAGEMENT

    Older adults tend to be on many medications and live on fixed incomes.

    “Cost may be an especially important consideration, as older adults tend to be on many medications and live on fixed incomes (97).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [97] Zhang, 2018, 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 source

      The Abstract (Conclusions; page unavailable) identifies economic pressure as a reason for medication underuse, and Research Design and Methods (Health and comorbid conditions; page unavailable) says comorbid conditions can increase out-of-pocket costs. The paper does not say that older adults generally take many medications or live on fixed incomes; its Socio-economic strata section instead describes several possible income sources. (LLM, conf=0.80)

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    Premisecitation
    § LIFESTYLE MANAGEMENT

    The benefits of a structured exercise program (as in the 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 (84).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [84] 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 section (Major mobility disability; page not provided) reports fewer cases in the physical-activity group than in the health-education group (30.1% versus 35.5%). The Results section (Intervention adherence; page not provided) reports more moderate activity, but does not establish reduced sedentary time; the copy also does not report reduced frailty. Participants were sedentary older adults with physical limitations, not specifically identified as frail. (LLM, conf=0.88)

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

    Among secondary outcomes in WISDM, 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 [40] 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 [41] 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, with the cited 95% CI of 6.0–11.5. Table 2 also reports a decrease in glycemic variability (%CV). The citing sentence gives the increase as 8% rather than 8.8%. (LLM, conf=0.88)

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    Premisecitation
    § Beyond Glycemic Management

    There is less evidence for lipid-lowering therapy and aspirin therapy, although the benefits of these interventions for primary and secondary prevention are likely to apply to older adults whose life expectancies equal or exceed the time frames of the clinical trials.

    “There is less evidence for lipid-lowering therapy and aspirin therapy, although the benefits of these interventions for primary and secondary prevention are likely to apply to older adults whose life expectancies equal or exceed the time frames of the clinical trials (74).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [74] Gencer, 2020, Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials, Lancet source

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

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    Premisecitation
    § TREATMENT GOALS

    The 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 (56).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [56] 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 intensive lifestyle intervention in Look AHEAD had multiple clinical benefits including 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 (87).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [87] Wing, 2013, Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes, N Engl J Med source

      The Results sections report greater weight loss, improved fitness and waist circumference, better A1c and systolic blood pressure, and lower use of antihypertensives, statins and insulin in the intervention group. The Cardiovascular Disease Risk Factors section says that all measured risk factors except LDL improved initially, but our copy does not specifically identify HDL cholesterol or report that it increased. (LLM, conf=0.83)

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    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 or dynapenia 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 or dynapenia (76) and/or osteopenia (77,78).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [76] Mori, 2021, High prevalence and clinical impact of dynapenia and sarcopenia in Japanese patients with type 1 and type 2 diabetes: findings from the Impact of Diabetes Mellitus on Dynapenia study, J Diabetes Investig source

      The Results and Discussion (page unavailable) report lower muscle mass and strength in older patients with diabetes, declining measures with age, and higher prevalences of sarcopenia and dynapenia. They do not establish accelerated muscle-mass loss or assess muscle quality; the Discussion says intramuscular fat was not evaluated. Osteopenia is attached to different citations in the citing sentence. (LLM, conf=0.86)

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    • cites [77] 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
    • cites [78] Park, 2006, Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study, Diabetes source

      The Abstract and Discussion report lower muscle strength and quality in older adults with type 2 diabetes. They do not establish accelerated muscle-mass loss or subsequent sarcopenia or dynapenia: the study found greater arm and leg muscle mass in participants with diabetes, and the Discussion says prospective research is needed to examine muscle-mass loss. Osteopenia is attached to different citations (77, 78), so it is not assessed against this source. (LLM, conf=0.90)

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

    In contrast to the ORACL study, no significant differences in hypoglycemia were observed in the Boughton et al. trial.

    “In contrast to the ORACL study, no significant differences in hypoglycemia were observed.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [48] Boughton, 2022, Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study, Lancet Healthy Longev source

  • 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 (134).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [134] Bradley, 2021, Severe hypoglycemia risk with long-acting insulin analogs vs neutral protamine Hagedorn insulin, JAMA Intern Med source

      The Results report that, among Medicare patients aged 65 or older with type 2 diabetes, long-acting insulin analogs were associated with fewer emergency visits or hospitalizations for hypoglycemia than NPH insulin. The paper does not establish that once-daily basal insulin has minimal side effects overall or recommend it as a reasonable option for many older adults; it also notes that the lower hypoglycemia risk was not seen with concomitant prandial insulin. (LLM, conf=0.84)

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    Premisecitation
    § Other Factors to Consider

    Inadequate social support and reduced access to long-term services and support may reduce quality of life and increase the risk of functional dependency.

    “Inadequate social support and reduced access to long-term services and support may reduce these individuals' quality of life and increase the risk of functional dependency (7).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • 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 and diabetes complications are associated with lower health-related quality of life in older adults with diabetes. The passages searched for social support, long-term services, and functional dependency do not address whether inadequate support or reduced service access affects either outcome. (LLM, conf=0.76)

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    Premisecitation
    § SPECIAL CONSIDERATIONS FOR OLDER ADULTS WITH TYPE 1 DIABETES

    An observational study of older adults with diabetes living in LTC facilities using CGM revealed a high prevalence of hypoglycemia both in people using insulin and in those using sulfonylureas, showing that this population is at increased risk for hypoglycemia.

    “Furthermore, an observational study of older adults with diabetes living in LTC facilities using CGM revealed a high prevalence of hypoglycemia both in people using insulin and in those using sulfonylureas, thus showing that this population of older adults in LTC facilities are at increased risk for hypoglycemia (141).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [141] Fløde, 2023, High number of hypoglycaemic episodes identified by CGM among home-dwelling older people with diabetes: an observational study in Norway, BMC Endocr Disord source

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

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    Premisecitation
    § Insulin Secretagogues

    Glyburide is a longer-acting sulfonylurea and should be avoided in older adults.

    “Glyburide is a longer-acting sulfonylurea and should be avoided in older adults (117).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [117] 2023, American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults, J Am Geriatr Soc source

      The Results section identifies glyburide as a longer-acting sulfonylurea and recommends avoiding sulfonylureas as first- or second-line therapy in older adults. The claim omits that treatment qualifier: the paper says that if a sulfonylurea must be used, a short-acting agent is preferred, rather than stating an unconditional prohibition on glyburide. (LLM, conf=0.84)

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    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 of these people 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 (136-138).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [136] Livingstone, 2015, Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010, JAMA source

      The Abstract (Importance) notes major advances in type 1 diabetes treatment, and the Discussion reports higher life expectancy than earlier estimates from other populations. But the Discussion says the study cannot directly establish improvement over time, and our copy does not link any improvement to treatment or show that the population over age 65 is growing. (LLM, conf=0.86)

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    • cites [137] Miller, 2012, Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort, Diabetes source

      The Abstract reports that life expectancy was about 15 years greater in the Pittsburgh cohort diagnosed in 1965–1980 than in the cohort diagnosed in 1950–1964. The Discussion identifies improved treatment, glucose monitoring, and insulin administration as possible contributors. The paper does not establish that the population of people with type 1 diabetes over age 65 is growing. (LLM, conf=0.88)

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    • cites [138] Bullard, 2018, Prevalence of diagnosed diabetes in adults by diabetes type - United States, 2016, MMWR Morb Mortal Wkly Rep source

      The 2016 prevalence table reports type 1 diabetes among adults aged ≥65, but provides no trend showing that this population is growing. The Discussion says it is not known whether a reported overall diabetes-prevalence trend differs for type 1 diabetes. Searches for longer survival and modern management found no passage linking either to growth in the older population. (LLM, conf=0.75)

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    Premisecitation
    § SPECIAL CONSIDERATIONS FOR OLDER ADULTS WITH TYPE 1 DIABETES

    A feasibility study in LTC facilities showed that CGM can be useful in older adults with diabetes, although it requires substantial staff training.

    “Nevertheless, a feasibility study in LTC facilities showed that CGM can be useful in older adults with diabetes, although it requires substantial staff training (140).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [140] Larsen, 2021, Continuous glucose monitoring in older people with diabetes receiving home care—a feasibility study, Pilot Feasibility Stud source

      The Results (Feasibility of CGM) and Discussion support that CGM was feasible and useful for detecting hypoglycemia in older adults with diabetes receiving home care, not in long-term care facilities. The Abstract Results and Key messages say extensive training was needed for personnel administering the MMSE questionnaire, not for CGM; they describe personnel effort as reasonable. (LLM, conf=0.91)

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    Premisecitation
    § Insulin Secretagogues

    Sulfonylureas and other insulin secretagogues such as meglitinides are associated with hypoglycemia, bone loss, and fracture risk.

    “Sulfonylureas and other insulin secretagogues such as the meglitinides (repaglinide and nateglinide) are associated with hypoglycemia, bone loss (115), and fracture risk (116) and should be used with caution.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [115] Tramontana, 2024, More rapid bone mineral density loss in older men with diabetes: the Osteoporotic Fractures in Men (MrOS) study, J Clin Endocrinol Metab source
    • cites [116] Napoli, 2014, Fracture risk in diabetic elderly men: the MrOS study, Diabetologia source

      The Results report an association between sulfonylurea use and increased fracture risk in older men with diabetes (HR 1.66; 95% CI 1.09–2.51). The cited paper does not report a fracture-risk finding for meglitinides; the separate bone-loss citation is not being judged here. No page numbers are available in our copy. (LLM, conf=0.88)

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    Premisecitation
    § SPECIAL CONSIDERATIONS FOR OLDER ADULTS WITH TYPE 1 DIABETES

    In the randomized controlled trial, there were no differences in TIR, time below range, or mean glucose levels.

    “There were no differences in TIR, time below range, or mean glucose levels (142).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [142] Idrees, 2024, Continuous glucose monitoring-guided insulin administration in long-term care facilities: a randomized clinical trial, J Am Med Dir Assoc source

  • May combine two claims.

    Premisecitation
    § Pioglitazone

    Pioglitazone is associated with heart failure, fluid retention, weight gain, osteoporosis, falls or fractures, and/or macular edema.

    “Pioglitazone, if used at all, should be used very cautiously in older adults on insulin therapy as well as in those with or at risk for heart failure, fluid retention, weight gain, osteoporosis, falls or fractures, and/or macular edema (113,114).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [113] Schwartz, 2015, Effects of TZD use and discontinuation on fracture rates in ACCORD bone study, J Clin Endocrinol Metab source

      The Discussion reports prior evidence of increased fracture risk with pioglitazone and bone loss in some populations, while noting that ACCORD could not assess pioglitazone separately from rosiglitazone. The paper does not establish the other attributed concerns—heart failure, fluid retention, weight gain, falls, or macular edema—or a specific risk from use with insulin. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [114] Billington, 2015, The effect of thiazolidinediones on bone mineral density and bone turnover: systematic review and meta-analysis, Diabetologia source

      The Results (Study characteristics; page not provided) report reduced bone mineral density with thiazolidinediones, and the subgroup analysis says findings for pioglitazone were similar. The Discussion advises caution in older patients and those at high risk of fracture. The paper does not substantiate the sentence’s other cautions about heart failure, fluid retention, weight gain, falls, macular edema, or insulin therapy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § LIFESTYLE MANAGEMENT

    Deintensification is safe and possibly beneficial for older adults.

    “There are now multiple studies evaluating deintensification protocols in diabetes as well as hypertension, demonstrating that deintensification is safe and possibly beneficial for older adults (105).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [105] Seidu, 2019, Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes, Diabetes Obes Metab source

      The conclusion (p. 10) says limited evidence suggests deintensification’s benefits outweigh its harms in older people with type 2 diabetes. But the review does not establish that deintensification is uniformly safe: the Mortality section (p. 9) reports increased mortality associated with discontinuing antihyperglycaemic or blood-pressure-lowering therapy in two studies. Only one included study examined blood-pressure-lowering therapy (section 3.3, p. 4), so the sentence also overstates the evidence for hypertension. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § SPECIAL CONSIDERATIONS FOR OLDER ADULTS WITH TYPE 1 DIABETES

    A recent randomized controlled trial in LTC facilities showed that real-time CGM use for up to 60 days was safe and effective in guiding insulin doses compared with BGM by point of care.

    “Of note, a recent randomized controlled trial in LTC facilities showed that real-time CGM use for up to 60 days was safe and effective in guiding insulin doses compared with BGM by point of care.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [142] Idrees, 2024, Continuous glucose monitoring-guided insulin administration in long-term care facilities: a randomized clinical trial, J Am Med Dir Assoc source

  • 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 (104,153) and is clearly relevant for palliative care.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [104] 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 intensive glucose control carries risks, especially for older or frail patients, and argues for greater attention to deintensification. But this study measures how often glycemic medications were reduced; it does not establish the safety or efficacy of deintensification protocols, and it does not study blood-pressure deintensification. The palliative-care relevance is the citing authors’ own framing. (LLM, conf=0.79)

      Experimental — accuracy not yet measured
    • cites [153] 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 in patients aged 80 or older. 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, so it does not establish safety. Glucose management is covered by the sentence’s other citation; relevance to palliative care is the citing authors’ framing. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • 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 (135).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [135] Diabetes Management Writing Group, 2024, Clinical practice guideline for diabetes management in the post-acute and long-term care setting, J Am Med Dir Assoc source

      The abstract (page not available) discusses aligning diabetes management with patients’ goals of care, but does not describe harms from transitions between care settings. Searches for transitions, dosing errors, and changes in nutrition or activity found no passage in our copy addressing the claimed effects. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Incretin-Based Therapies

    DPP-4 inhibitors are relatively weak agents and do not reduce or increase major adverse cardiovascular outcomes generally, and there is no interaction by age-group.

    “DPP-4 inhibitors are relatively weak agents and do not reduce or increase major adverse cardiovascular outcomes generally, and there is no interaction by age-group (121).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [121] Bilal, 2024, Effects of newer anti-hyperglycemic agents on cardiovascular outcomes in older adults: systematic review and meta-analysis, J Diabetes Complications source

      The DPP-4 results passage (labeled Conclusion; page unavailable) reports no significant difference in MACE versus placebo and no significant interaction between the <65 and ≥65 age groups. The passage following Figure 5 likewise reports no cardiovascular-outcome benefit. Our copy does not characterize DPP-4 inhibitors as “relatively weak agents,” so that part of the attributed claim is unsupported. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

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

    Premisecitation
    § 13.1

    Over 29% of people over the age of 65 years have diabetes.

    “Over 29% of people over the age of 65 years have diabetes (1,2).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Laiteerapong, 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2] Centers for Disease Control and Prevention . National Diabetes Statistics Report. 2024. Accessed 31 August 2024. Available from https://www.cdc.gov/diabetes/php/data-research/index.html

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § NEUROCOGNITIVE FUNCTION

    Both hyperglycemia and hypoglycemia are associated with a decline in cognitive function.

    “Both hyperglycemia and hypoglycemia are associated with a decline in cognitive function (16)(17)(18), and longer duration of diabetes is associated with worsening cognitive function.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (16)(17)(18)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation
    § 13.1

    Older adults with diabetes 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.

    “At the same time, older adults with diabetes 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 paperNot a substantial claim0 of 1 sources checked
    • cites [1] Laiteerapong, 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

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

    Premisecitation
    § 13.1

    The Institute for Healthcare Improvement has developed an evidence-based 4Ms framework for age-friendly health care that is being adopted by many health systems caring for older adults.

    “The Institute for Healthcare Improvement has developed an evidence-based “4Ms” framework for age-friendly health care that is being adopted by many health systems caring for older adults.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Cacchione, 2020, Age-friendly health systems: the 4Ms framework, Clin Nurs Res source

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

    Premisecitation
    § TREATMENT GOALS

    Serum glycated protein assays such as fructosamine may also be useful for glycemic monitoring in conjunction with other measures.

    “Serum glycated protein assays such as fructosamine may also be useful for glycemic monitoring in conjunction with other measures (see Section 6, “Glycemic Goals and Hypoglycemia”) (60)(61)(62).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (60)(61)(62)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation
    § 13.4

    Cognitive decline has been associated with increased risk of hypoglycemia, and conversely, 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 (33)(34)(35).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites (33)(34)(35)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation
    § LIFESTYLE MANAGEMENT

    Special care is required in prescribing and monitoring pharmacologic therapies in older adults.

    “Special care is required in prescribing and monitoring pharmacologic therapies in older adults (96),”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [96] Valencia, 2014, Pharmacological treatment of diabetes in older people, Diabetes Obes Metab source

  • May combine two claims.

    Interpretationreasoning
    § NEUROCOGNITIVE FUNCTION

    These factors increase risk for hypoglycemia, which can worsen cognitive function and have multiple other adverse effects in older individuals with diabetes.

    “These factors increase risk for hypoglycemia, which, in turn, can worsen cognitive function and have multiple other adverse effects in older individuals with diabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning
    § Beyond Glycemic Management

    Although minimizing hyperglycemia may be important in older individuals with diabetes, greater reductions in morbidity and mortality are likely to result from a clinical focus on comprehensive cardiovascular risk factor modification.

    “Although minimizing hyperglycemia may be important in older individuals with diabetes, greater reductions in morbidity and mortality are likely to result from a clinical focus on comprehensive cardiovascular risk factor modification.”
    Quote in the paperSubstantial claim

  • May combine two claims.

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

    Observational data from the DCCT/EDIC study indicate that among older adults (mean age 58 years) with long-standing type 1 diabetes, routine CGM and insulin pump use was associated with fewer hypoglycemic events and hyperglycemic excursions and lower A1C levels.

    “These and other short-term trials are supported by observational data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study indicating that among older adults (mean age 58 years) with long-standing type 1 diabetes, routine CGM and insulin pump use was associated with fewer hypoglycemic events and hyperglycemic excursions and”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Gubitosi-Klug, 2022, Continuous glucose monitoring in adults with type 1 diabetes with 35 years duration from the DCCT/EDIC study, Diabetes Care source

  • May combine two claims.

    Premisecitation
    § LIFESTYLE MANAGEMENT

    Older adults with diabetes may have cognitive impairment and functional impairment.

    “Special care is required in prescribing and monitoring pharmacologic therapies in older adults (96), who are at high risk of polypharmacy, have difficulties in maintaining prescribed medication plans, and may have cognitive impairment and functional impairment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [96] Valencia, 2014, Pharmacological treatment of diabetes in older people, Diabetes Obes Metab source

  • May combine two claims.

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

    In the MOBILE analysis, the increase in time in range at 8 months was greater in the older adult group than in the younger adult group (19% vs 12%, P = 0.01) and the decrease in time above range was greater in the older adult group.

    “Similarly, the increase in time in range (TIR) at 8 months was greater in the older adult group than in the younger adult group (19% vs. 12%, P = 0.01) and the decrease in time above range was greater in the older adult group as well, which shows that CGM benefits extend to older adults with type 2 diabetes who are nonintensively treated (46).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] Bao, 2022, Effectiveness of continuous glucose monitoring in older adults with type 2 diabetes treated with basal insulin, Diabetes Technol Ther source

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

    Premisecitation
    § 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; however, 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 (139).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [139] 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 S2 (checkable).

    Interpretationreasoning
    § END-OF-LIFE CARE

    The management of diabetes in older adults at the end of life necessitates a person-centered approach that prioritizes comfort, symptom management, quality of life, and the preservation of dignity.

    “In conclusion, the management of diabetes in older adults at the end of life necessitates a person-centered approach that prioritizes comfort, symptom management, quality of life, and the preservation of dignity.”
    Quote in the paperNot a substantial claim

  • 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 (45)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] 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
42 of 42

  • The paper relies on this without support.

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

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

  • The paper relies on this without support.

    Management of blood pressure and cholesterol lowering with statins have been associated with a reduced risk of incident dementia.

    “Management 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.

    Life expectancy is affected by the age of the individual, disease burden, and degree of disability.

    “Life expectancy is affected by the age of the individual, disease burden, and degree of disability.”

  • The paper relies on this without support.

    Diabetes is recognized as an independent risk factor for frailty.

    “Diabetes is also recognized as an independent risk factor for frailty.”

  • The paper relies on this without support.

    Inadequate nutritional intake, particularly inadequate protein intake, can increase the risk of sarcopenia and frailty in older adults.

    “Inadequate nutritional intake, particularly inadequate protein intake, can increase the risk of sarcopenia and frailty in older adults.”

  • The paper relies on this without support.

    Metformin is contraindicated in those with advanced renal insufficiency.

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

  • The paper relies on this without support.

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

    “Additionally, metformin 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.

    GLP-1 RAs may be associated with nausea, vomiting, diarrhea, or constipation.

    “GLP-1 RAs may also be associated with nausea, vomiting, diarrhea, or constipation and should be titrated slowly.”

  • The paper relies on this without support.

    Insulin therapy requires that individuals or their caregivers have good visual and motor skills and cognitive ability to manage the appropriate insulin dose using insulin pens or syringes.

    “The use of insulin therapy requires that individuals or their caregivers have good visual and motor skills and cognitive ability to manage the appropriate insulin dose using insulin pens or syringes.”

  • 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.

    Diabetic ketoacidosis may be mistaken for sepsis, end-organ failure, or other electrolyte abnormalities.

    “Diabetic ketoacidosis may be mistaken for sepsis, end-organ failure, or other electrolyte abnormalities.”

  • The paper relies on this without support.

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

    “An older adult residing in a PALTC facility may have irregular and unpredictable meal consumption, undernutrition, anorexia, and impaired swallowing.”

  • The paper relies on this without support.

    Therapeutic nutrition plans or modified food consistencies may inadvertently lead to decreased food intake and contribute to unintentional weight loss and undernutrition.

    “Furthermore, therapeutic nutrition plans or modified food consistencies may inadvertently lead to decreased food intake and contribute to unintentional weight loss and undernutrition.”

  • The paper relies on this without support.

    According to federal guidelines, at a minimum, assessments should be done at least every 30 days for the first 90 days after admission and then at least once every 60 days and as clinically indicated.

    “According to federal guidelines, at a minimum, assessments should be done at least every 30 days for the first 90 days after admission and then at least once every 60 days and as clinically indicated.”

  • The paper relies on this without support.

    There is no role for A1C monitoring in a stable individual with advanced disease.

    “There is no role for A1C monitoring.”

  • The paper relies on this without support.

    In an individual with organ failure, preventing hypoglycemia is of greatest significance.

    “An individual with organ failure: Preventing hypoglycemia is of greatest significance.”
17 of 17

Self-check

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

Each contradiction between two passages listed here was confirmed by an independent check.

  • Boughton et al. are not reference 48

    Minor

    The cited trial is attributed to Boughton et al. (48), but reference 48 lists Bandeen-Roche et al. and concerns frailty.

  • Citation (3) identifies a different report

    Minor

    The text directs readers to a report titled "Diabetes in Older Adults" as reference 3, but reference 3 is a paper titled "Psychosocial care for people with diabetes."

2 of 2

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 (2024-12-09). 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 2024-12-09

1 of 1

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 2

  1. Laiteerapong, 2018, Diabetes in America
  2. Sinclair, 2013, International Diabetes Federation (IDF) Global Guideline for Managing Older People with Type 2 Diabetes, International Diabetes Federation

Cited by

Sorted by citations

Related

Authors
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., Garg, R., Khunti, K., Lal, R., Lingvay, I., Matfin, G., Napoli, N., Pandya, N., Pekas, E. J., Pilla, S. J., Polsky, S., Segal, A. R., Seley, J. J., Stanton, R. C., & Bannuru, R. R.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2024-12-09
Volume
48
Issue
Supplement_1
Pages
S266-S282
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc25-s013
PMC
PMC11635042
OpenAlex
W4405187507
Semantic Scholar
2db9864d5ed37f145f901184a8ff8f915982ada2
Cited by
209
References
155
Citations by year
2026: 93 · 2025: 102 · 2024: 14
FWCI
12.47
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 Institutes of Health (5k23dk121942-05)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
diabetes in older adults, clinical guidelines, quality of care, treatment goals, level of evidence
MeSH terms
Aged, Aged, 80 and over, Diabetes Mellitus, Humans, 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.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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