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Cited by 211Diabetes Treatment and ManagementDiabetes Management and EducationDiabetes Management and Research

The DOI matches its Crossref record; 167 of the 167 references it cites were found in a registry or an index; 84 of the 135 sources its claims cite were checked for support.

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, Echouffo-Tcheugui, Justin B., Ekhlaspour, Laya, Garg, Rajesh, Khunti, Kamlesh, Lal, Rayhan, Lingvay, Ildiko, Matfin, Glenn, Napoli, Nicola, Pandya, Naushira, Pekas, Elizabeth J., Pilla, Scott J., Polsky, Sarit, Segal, Alissa R., Seley, Jane Jeffrie, Stanton, Robert C., Bannuru, Raveendhara R.·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.

Overview

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

167 of 167 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

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

  • It may state two separate claims as one. 36
  • Probably not a substantial claim. 8
  • The quote only partly states this claim. 1
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

Citations

Cites

1 retracted

Flagged first, then by citations

Show all 155 references

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

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Metadata

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.

A language model drew the claims from the paper on 2026-10-27, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-27 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

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