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

In the paper

“Older adults with diabetes are at higher risk of cognitive decline and institutionalization (13,14).”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• Partly supported

  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)

  cites [14] Roberts, 2014, Association of type 2 diabetes with brain atrophy and cognitive impairment, Neurology sourceExperimental — accuracy not yet measured

In the paper

“People with diabetes have higher incidences of all-cause dementia, Alzheimer disease, and vascular dementia than people without diabetes (15).”

What the sources say

• Partly supported

  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)

  cites [15] Xu, 2009, Uncontrolled diabetes increases the risk of Alzheimer's disease: a population-based cohort study, Diabetologia sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“These data may be a useful starting point to inform decisions about selecting less stringent glycemic goals (56,57).”

What the sources say

• Supported

  The Discussion says LEAD could inform shared decision-making about treatment targets, including relaxing glycemic targets for older adults with limited life expectancy. This supports the hedged claim that its data may be a starting point for such decisions. (LLM, conf=0.92)

  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
• Supported

  In the section “Incorporating Prognosis into Clinical Decision-Making for Older Adults with Diabetes” (page unavailable), the paper says glycemic targets may reasonably be relaxed for some older adults and uses an estimated life expectancy to discuss an individualized HbA1c goal. It also says life-expectancy estimates should not be the sole basis for decisions, consistent with using the data as a starting point. (LLM, conf=0.90)

  cites [57] Deardorff, 2023, Incorporating prognosis into clinical decision-making for older adults with diabetes, J Gen Intern Med source

In the paper

“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).”

What the sources say

• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“Cost may be an especially important consideration, as older adults tend to be on many medications and live on fixed incomes (97).”

What the sources say

• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• Partly supported

  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)

  cites [41] Pratley, 2020, Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial, JAMA sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

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

  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 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Supported

  The Introduction says LEAD was developed for older adults with diabetes, and the Conclusions report good performance in validation cohorts. The Results link higher scores to shorter predicted life expectancy: a score of 11 or more corresponded to a median of 1.5 years and a 6% probability of surviving at least five years. Page numbers are not available in our copy. (LLM, conf=0.94)

  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

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites [87] Wing, 2013, Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes, N Engl J Med sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured
• Supported

  The Results (p. 1) report greater declines in leg muscle mass, strength, and quality among older adults with type 2 diabetes. The discussion (p. 3) defines sarcopenia as decreased muscle mass and links type 2 diabetes to rapid loss of muscle mass and strength, supporting the hedged possibility cited as (76). Osteopenia is attached to different citations (77,78), so it is not attributed to this source. (LLM, conf=0.87)

  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
• Partly supported

  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)

  cites [78] Park, 2006, Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study, Diabetes sourceExperimental — accuracy not yet measured

In the paper

“In contrast to the ORACL study, no significant differences in hypoglycemia were observed.”

What the sources say

• Supported

  The Results report no difference between closed-loop and sensor-augmented pump therapy in time spent with glucose below 3·9 mmol/L. They also report no significant difference at the lower thresholds of 3·5 and 3·0 mmol/L. The passages do not provide page numbers. (LLM, conf=0.92)

  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

In the paper

“Once-daily basal insulin injection therapy is associated with minimal side effects and may be a reasonable option in many older adults (134).”

What the sources say

• Partly supported

  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)

  cites [134] Bradley, 2021, Severe hypoglycemia risk with long-acting insulin analogs vs neutral protamine Hagedorn insulin, JAMA Intern Med sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• ?Could not verify

  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)

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

In the paper

“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).”

What the sources say

• Partly supported

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

  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 sourceExperimental — accuracy not yet measured

In the paper

“Glyburide is a longer-acting sulfonylurea and should be avoided in older adults (117).”

What the sources say

• Partly supported

  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)

  cites [117] 2023, American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults, J Am Geriatr Soc sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites [136] Livingstone, 2015, Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010, JAMA sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites [137] Miller, 2012, Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort, Diabetes sourceExperimental — accuracy not yet measured
• ?Could not verify

  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)

  cites [138] Bullard, 2018, Prevalence of diagnosed diabetes in adults by diabetes type - United States, 2016, MMWR Morb Mortal Wkly Rep sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites [140] Larsen, 2021, Continuous glucose monitoring in older people with diabetes receiving home care—a feasibility study, Pilot Feasibility Stud sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• Partly supported

  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)

  cites [116] Napoli, 2014, Fracture risk in diabetic elderly men: the MrOS study, Diabetologia sourceExperimental — accuracy not yet measured

In the paper

“There were no differences in TIR, time below range, or mean glucose levels (142).”

What the sources say

• Supported

  The Abstract Results and Results sections report no statistically significant differences between the rt-CGM and POC groups in time in range, time below range, or mean CGM glucose. The paper identifies the study as a randomized controlled trial. (LLM, conf=0.94)

  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

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites [113] Schwartz, 2015, Effects of TZD use and discontinuation on fracture rates in ACCORD bone study, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
• Partly supported

  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)

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

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites [105] Seidu, 2019, Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes, Diabetes Obes Metab sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• Supported

  The Materials and methods section describes random assignment to real-time CGM or point-of-care testing, with follow-up for up to 60 days. The Conclusions and Implications section states that CGM-guided insulin therapy in long-term care facilities was safe and effective, with similar improvement in glycemic control and no increase in hypoglycemia. (LLM, conf=0.94)

  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

In the paper

“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.”

What the sources say

• Partly supported

  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)

  cites [104] McAlister, 2017, Treatment deintensification is uncommon in adults with type 2 diabetes mellitus: a retrospective cohort study, Circ Cardiovasc Qual Outcomes sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“Unfortunately, these transitions can lead to discontinuity in goals of care, errors in dosing, and changes in nutrition and activity (135).”

What the sources say

• ?Could not verify

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites [121] Bilal, 2024, Effects of newer anti-hyperglycemic agents on cardiovascular outcomes in older adults: systematic review and meta-analysis, J Diabetes Complications sourceExperimental — accuracy not yet measured

In the paper

“Over 29% of people over the age of 65 years have diabetes (1,2).”

What the sources say

• ?Not matched

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

  cites [1] Laiteerapong, 2018
• Not checked yetcites [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

In the paper

“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.”

What the sources say

• ?Not matched

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

  cites (16)(17)(18)

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites [1] Laiteerapong, 2018

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [8] Cacchione, 2020, Age-friendly health systems: the 4Ms framework, Clin Nurs Res source

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites (60)(61)(62)

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites (33)(34)(35)

In the paper

“Special care is required in prescribing and monitoring pharmacologic therapies in older adults (96),”

What the sources say

• ?Not checked — no full text of the sourcecites [96] Valencia, 2014, Pharmacological treatment of diabetes in older people, Diabetes Obes Metab source

In the paper

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

In the paper

“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.”

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [96] Valencia, 2014, Pharmacological treatment of diabetes in older people, Diabetes Obes Metab source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites [46] Bao, 2022, Effectiveness of continuous glucose monitoring in older adults with type 2 diabetes treated with basal insulin, Diabetes Technol Ther source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

“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)”

What the sources say

• ?Not checked — no full text of the sourcecites [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