CoChat
Sign Up
Cited by 87Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes Management and Education

13. Older Adults: Standards of Care in Diabetes—2026

Open access
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, Mandeep, McCoy, Rozalina G., Balapattabi, Kirthikaa, Bannuru, Raveendhara R., Bellini, Natalie J., Bennett, Allison K., Beverly, Elizabeth A. +19 more·2026·Diabetes Care
DOI 10.2337/dc26-s013PMC PMC12690186
Open this paper in CoChat — free account

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 for Diabetes, 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 2026 clinical practice recommendations for older adults with diabetes, emphasizing comprehensive geriatric assessment, individualized glycemic goals, hypoglycemia avoidance, and treatment deintensification. It synthesizes evidence on CGM and advanced insulin delivery, lifestyle management, pharmacotherapy, long-term care, and end-of-life care.

Key findings

  • Over 29% of people over age 65 years have diabetes, and older adults with diabetes have higher rates of functional disability, frailty, cognitive impairment, and geriatric syndromes than those without diabetes.
  • Glycemic goals should be individualized: A1C <7.0–7.5% (<53–58 mmol/mol) for healthy older adults with intact function; A1C <8.0% (<64 mmol/mol) for complex/intermediate health; and avoidance of reliance on A1C for very complex/poor health, focusing on avoiding hypoglycemia and symptomatic hyperglycemia.
  • CGM is recommended for older adults with type 1 diabetes (A) and type 2 diabetes on insulin (B); automated insulin delivery may be considered based on individual ability and support. Trials cited include ORACL (30 older adults, mean age 67 years), AIDE T1D (82 adults aged ≥65 years), and a Medicare real-world analysis (4,243 individuals, mean age 67.4 years) showing a 10% increase in time in range.
  • Lifestyle recommendations include healthful eating with protein intake at least 0.8 g/kg/day, regular aerobic/weight-bearing/resistance activity, and consideration of intensive lifestyle intervention with 5–7% weight loss for older adults with type 2 diabetes, overweight/obesity, and capacity to exercise safely.

Methods

  • This is an annual ADA Standards of Care section, developed by the ADA Professional Practice Committee for Diabetes, an interprofessional expert committee, with evidence-graded clinical practice recommendations.
  • It is a narrative synthesis of existing literature, trials, systematic reviews, and guidelines rather than a primary study; no original sample or dataset is analyzed.
  • Recommendations cover assessment, neurocognitive function, hypoglycemia, CGM/advanced insulin delivery, treatment goals, lifestyle, pharmacotherapy, long-term care, and end-of-life care.

Limitations

  • The paper states there are few long-term studies in older adults demonstrating benefits of intensive glycemic, blood pressure, and lipid management; it also notes no global consensus on the optimal classification strategy for older adults with diabetes and no consensus for end-of-life management of type 1 diabetes.
  • The paper states additional research is needed to develop a reproducible classification scheme and to study diabetes care in post-acute and long-term care settings.
  • Evident from the text: this is a consensus guideline, not a primary comparative study, and many recommendations are graded E (expert opinion) or rely on extrapolation from younger populations or small older-adult trials.

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

Integrity signals

Registry

Crossref · 10.2337/dc26-s013

Cites

196 of 196 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

129 of 205 cited sources checked · 35 supported · 0 flagged · accuracy not yet measured

  • Premisecitation
    § Abstract

    Cardioprotective glucose-lowering therapies were not associated with a reduction in all-cause dementia.

    “A systematic review and meta-analysis found that although cardioprotective glucose-lowering therapies were not associated with a reduction in all-cause dementia, GLP-1 RAs were associated with a statistically significant reduction in all-cause dementia (28).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [28] Seminar, 2025, Cardioprotective glucose-lowering agents and dementia risk: a systematic review and meta-analysis, JAMA Neurol source

      The Results section reports no statistically significant reduction when all cardioprotective glucose-lowering drug classes were pooled, and a significant reduction for GLP-1RAs. However, Methods > Outcomes defines the analyzed endpoint as dementia or cognitive impairment, using a composite where dementia alone was unavailable. The cited results therefore do not establish either statement specifically for all-cause dementia alone. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation
    § Abstract

    Older adults with diabetes are at higher risk of cognitive decline and institutionalization than older adults without diabetes.

    “Older adults with diabetes are at higher risk of cognitive decline and institutionalization than older adults without diabetes (17–19).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [17] 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 [18] Roberts, 2014, Association of type 2 diabetes with brain atrophy and cognitive impairment, Neurology source

      The Abstract (page unavailable) reports that midlife diabetes was associated with prevalent mild cognitive impairment in older participants, supporting the cognitive-impairment part of the claim. It reports few effects of late-life-onset diabetes, and neither the Abstract nor the retrieved Discussion passages address institutionalization. The paper therefore does not support the full claim about older adults with diabetes generally or their risk of institutionalization. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [19] Rodríguez-Sánchez, 2017, Diabetes-associated factors as predictors of nursing home admission and costs in the elderly across Europe, J Am Med Dir Assoc source

      The Discussion and Conclusions report that diabetes predicts nursing home admission among older adults, supporting the institutionalization part. The paper treats cognitive impairment as a predictor of institutionalization, but does not establish that older adults with diabetes have a higher risk of cognitive decline than those without diabetes. Page numbers are not available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation
    § Abstract

    Studies on diabetes prevention or intensive glycemic and blood pressure management have not demonstrated a reduction in cognitive decline.

    “However, studies on diabetes prevention or intensive glycemic and blood pressure management have not demonstrated a reduction in cognitive decline (25,26).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [25] Launer, 2011, Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy, Lancet Neurol source

      The Discussion reports no cognitive benefit from intensive versus standard glycemic treatment in older people with long-standing type 2 diabetes. The paper does not establish the claim about diabetes-prevention studies or intensive blood-pressure management; its Introduction says no clinical trials had tested early intervention on brain outcomes in this population. No page numbers were available in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [26] Luchsinger, 2017, Metformin, lifestyle intervention, and cognition in the Diabetes Prevention Program Outcomes Study, Diabetes Care source
  • Premisecitation
    § Abstract

    CGM devices have been shown to be effective at improving glycemic management.

    “Continuous glucose monitoring (CGM) devices have been shown to be effective at improving glycemic management and acceptable to people of all age-groups, including older individuals with type 1 diabetes (44–48) or insulin-requiring type 2 diabetes (49,50).”
    Quote in the paperSubstantial claim1 of 7 sources checked
    • cites [44] 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 [45] Pratley, 2020, Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial, JAMA source
    • cites [46] Miller, 2022, Benefit of continuous glucose monitoring in reducing hypoglycemia is sustained through 12 months of use among older adults with type 1 diabetes, Diabetes Technol Ther source
    • cites [47] Gubitosi-Klug, 2022, Continuous glucose monitoring in adults with type 1 diabetes with 35 years duration from the DCCT/EDIC study, Diabetes Care source
    • cites [48] Munshi, 2025, Continuous glucose monitoring with geriatric principles in older adults with type 1 diabetes and hypoglycemia: a randomized controlled trial, Diabetes Care source
    • cites [49] 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
    • cites [50] Bao, 2022, Effectiveness of continuous glucose monitoring in older adults with type 2 diabetes treated with basal insulin, Diabetes Technol Ther source
  • Premisecitation
    § Abstract

    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 (37–39).”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [37] Feinkohl, 2014, Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study, Diabetes Care source
    • cites [38] Lee, 2018, Severe hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study, Diabetologia source
    • cites [39] Jacobson, 2021, Cognitive performance declines in older adults with type 1 diabetes: results from 32 years of follow-up in the DCCT and EDIC Study, Lancet Diabetes Endocrinol source

      The Results and Discussion (page not provided) link severe hypoglycemia to declining psychomotor and mental efficiency and to clinically significant cognitive impairment in older adults with type 1 diabetes. They do not establish an increased risk of dementia, which is the more specific outcome in the claim. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • May combine two claims. 56
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Premisecitation
    § Abstract

    In a different open-label, crossover design clinical trial in 37 older adults (aged ≥60 years), 16 weeks of treatment with a hybrid closed-loop advanced insulin delivery system improved TIR and reduced time above range compared with sensor-augmented pump therapy; however, no significant differences in hypoglycemia were observed.

    “In a different open-label, crossover design clinical trial in 37 older adults (aged ≥60 years), 16 weeks of treatment with a hybrid closed-loop advanced insulin delivery system improved TIR and reduced time above range compared with sensor-augmented pump therapy; however, in contrast to the ORACL study, no significant differences in hypoglycemia were observed (53).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [53] 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
    § Abstract

    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 (20).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] Xu, 2009, Uncontrolled diabetes increases the risk of Alzheimer’s disease: a population-based cohort study, Diabetologia source

      The Results report increased dementia, Alzheimer’s disease, and vascular dementia risk for people with undiagnosed diabetes, but not for diabetic patients with blood glucose below 7.8 mmol/l. The Abstract states that overall diabetes was related only to vascular dementia. The claim therefore overgeneralizes findings from a diabetes subgroup to all people with diabetes. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

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

    “Both hyperglycemia and hypoglycemia are associated with a decline in cognitive function (22,23), and longer duration of diabetes is associated with worsening cognitive function.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [22] Xiao, 2025, Association between glycated hemoglobin A1c levels, control status, and cognitive function in type 2 diabetes: a prospective cohort study, Sci Rep source

      The Discussion links sustained hyperglycemia to cognitive impairment and says hypoglycemic episodes can exacerbate brain injury. But it does not establish the claimed association between hypoglycemic episodes and cognitive decline; the Results report no significant association for lower mean HbA1c levels in the fully adjusted model. Page numbers were not provided in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [23] 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 Background says severe hypoglycemia can impair cognitive function, and the Discussion reports an association between hypoglycemic events and dementia risk. The Discussion also links high blood-sugar markers to dementia risk, but says the role of long-term glucose control in cognitive decline is unclear and notes that a trial found no significant difference in clinical cognitive decline. Thus the paper does not establish the claim about hyperglycemia and declining cognitive function as broadly as stated. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    Older adults may be at higher risk of hypoglycemia for many reasons, including irregular meal intake, particularly in the setting of requiring insulin therapy, and worsening kidney function.

    “Older adults may be at higher risk of hypoglycemia for many reasons, including irregular meal intake, particularly in the setting of requiring insulin therapy, and worsening kidney function (36).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [36] Lee, 2017, Risk factors for severe hypoglycemia in black and white adults with diabetes: the Atherosclerosis Risk in Communities (ARIC) study, Diabetes Care source

      The Abstract reports higher severe-hypoglycemia risk with older age and insulin use, and the Conclusions describe kidney disease as a risk factor. The Conclusions also link difficulty eating or preparing meals to hypoglycemia risk, but do not establish irregular meal intake—particularly while using insulin—as the claimed risk factor. The association with reduced kidney function was no longer statistically significant after adjustment. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    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) (23).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [23] 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

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

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation
    § Abstract

    Intensive glycemic management in older adults with complex health status and medication plans that increase hypoglycemia risk through insulin and/or sulfonylureas has been identified as overtreatment and is common in clinical practice.

    “Intensive glycemic management in older adults, particularly those with complex health status, with medication plans that increase the risk of hypoglycemia through use of insulin and/or sulfonylureas has been identified as overtreatment, is common in clinical practice”
    Quote in the paperSubstantial claim5 of 5 sources checked
    • cites [109] Arnold, 2018, Use of intensive glycemic management in older adults with diabetes mellitus, J Am Geriatr Soc source

      The Discussion (page unavailable) reports that about a quarter of older adults in the outpatient cohort had tight glucose control while taking medications with a high risk of hypoglycemia, and that comorbidities were associated with greater use of this approach. It names insulin and sulfonylureas, but describes the finding as suggesting *potential* overtreatment, not as establishing that every such treatment plan is overtreatment. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [110] Andreassen, 2014, Nursing home patients with diabetes: prevalence, drug treatment and glycemic control, Diabetes Res Clin Pract source

      The Discussion (page unavailable) says low glucose readings, low HbA1c values, and substantial insulin use suggest that some Norwegian nursing-home patients were overtreated. It does not establish that insulin- or sulfonylurea-based intensive treatment is commonly identified as overtreatment across older adults in clinical practice; its overtreatment conclusion is tentative and specific to the nursing-home population. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [111] Lipska, 2015, Potential overtreatment of diabetes mellitus in older adults with tight glycemic control, JAMA Intern Med source

      The Discussion reports that approximately 1 million older US adults with complex or very complex health attained tight glycemic control while using insulin or sulfonylureas, which may cause severe hypoglycemia. It calls this *potential* overtreatment, whereas the claim describes it as overtreatment without that qualification. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [112] Thorpe, 2015, Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia, Diabetes Care source

      The Results and Conclusions (page not available in our copy) show that tight glycemic control was common among older veterans with diabetes and dementia, and that 75% of tightly controlled patients used insulin and/or sulfonylureas. The paper describes this combination as a concern warranting possible deintensification, but its findings do not establish how common it is among older adults with complex health status generally. It also notes that tighter targets or insulin may be appropriate for some patients, so it does not classify every such regimen as overtreatment. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [113] 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 more than three quarters of frail patients or those with multiple comorbidities and HbA1C below 6.5% had no reduction in diabetes medication, and it links overtreatment to increased hypoglycemia risk. The WHAT IS KNOWN section also identifies elderly patients and those with comorbidities as especially vulnerable. However, the paper does not specifically identify insulin and/or sulfonylurea regimens in older adults with complex health status as the common overtreatment described; its cohort had a mean age of about 54 (patient-characteristics table). (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

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

    “Some older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty (58,59).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [58] Bandeen-Roche, 2015, Frailty in older adults: a nationally representative profile in the United States, J Gerontol A Biol Sci Med Sci source

      The Results report diabetes among frail older adults and describe multimorbidity, probable dementia, and difficulty with functional tasks by frailty status. They support the point that some older adults with diabetes are frail, but do not establish diabetes-related comorbidity or cognitive and physical limitations specifically among participants with diabetes. The cited passages have no page numbers in our copy. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [59] Kalyani, 2012, Hyperglycemia and incidence of frailty and lower extremity mobility limitations in older women, J Am Geriatr Soc source

      The Introduction associates diabetes in older adults with lower-extremity mobility limitations and frailty, supporting the physical-functioning and frailty portions of the claim. The Methods (Variables) record chronic conditions and neuropathy, but the cited passages do not establish substantial diabetes-related comorbidity or address limited cognitive functioning. Page numbers are unavailable in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    Older adults can be stratified for future risk for hypoglycemia with validated risk calculators (e.g., Kaiser Hypoglycemia Model for adults with type 2 diabetes) and with consideration of hypoglycemia risk factors.

    “Older adults can also be stratified for future risk for hypoglycemia with validated risk calculators (e.g., Kaiser Hypoglycemia Model for adults with type 2 diabetes) (40) and with consideration of hypoglycemia risk factors (Table 6.5).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [40] Karter, 2017, Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use, JAMA Intern Med source

      The Methods (Study Design) and Abstract (Results) describe a validated Kaiser Permanente tool that stratifies adults with type 2 diabetes by predicted 12-month risk. Its outcome is specifically hypoglycemia-related emergency department or hospital use, not hypoglycemia of any severity; the study population was adults generally, rather than older adults specifically. The separate reference to considering risk factors is tied to Table 6.5, not this citation. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation
    § Abstract

    Multiple studies evaluating deintensification protocols in diabetes and hypertension have shown that deintensification is safe and possibly beneficial for older adults.

    “Multiple studies evaluating deintensification protocols in diabetes and hypertension have shown that deintensification is safe and possibly beneficial for older adults”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [114] Seidu, 2019, Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes, Diabetes Obes Metab source

      The Abstract (p. 1) and Key findings (p. 9) report that most studies found no deterioration after deintensification in older adults with type 2 diabetes, and the authors suggest its benefits may outweigh its harms. But the review includes only one study of blood-pressure-lowering therapy (section 3.3, p. 4), and the Mortality section (p. 9) reports that discontinuing that therapy was associated with increased mortality. It therefore does not establish that deintensification is safe across both diabetes and hypertension. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

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

    “The geriatric class has the highest prevalence of obesity, hypertension, arthritis, and incontinence, while the cardiovascular class has the highest prevalence of myocardial infarctions, heart failure, and stroke.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [14] Laiteerapong, 2012, Classification of older adults who have diabetes by comorbid conditions, United States, 2005-2006, Prev Chronic Dis source

      The Results, under “Class characteristics” (page not supplied), report the highest estimated probabilities of obesity, hypertension, and incontinence in class 2, and of myocardial infarction, congestive heart failure, and stroke in class 3. The claim incorrectly assigns arthritis to the geriatric class: the paper places its highest estimated probability in class 3. (LLM, conf=0.91)

      Experimental — accuracy not yet measured
    • cites [69] Leung, 2021, Reexamining the classification of older adults with diabetes by comorbidities and exploring relationships with frailty, disability, and 5-year mortality, J Gerontol A Biol Sci Med Sci source

      The Results identify Class 2 as the geriatric-profile class and Class 3 as the cardiovascular-profile class, with the stated conditions generally more prevalent in those respective classes. However, the detailed Results report that arthritis was more prevalent in Class 3 than Class 2 in the 2005–2006 model (0.83 versus 0.74), so the unqualified claim about arthritis is not supported for both models. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [75] Huang, 2023, Data-driven classification of health status of older adults with diabetes: the diabetes and aging study, J Am Geriatr Soc source

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

    Premisecitation
    § Abstract

    Type 1 diabetes is increasingly diagnosed in older adulthood, with higher incidence in Western countries.

    “Type 1 diabetes is increasingly diagnosed in older adulthood as well, with greater awareness of and attention to appropriate diabetes classification across the life course, with higher incidence in Western countries (4).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [4] Tomic, 2025, The epidemiology of type 1 diabetes mellitus in older adults, Nat Rev Endocrinol source

      The Introduction says substantial numbers of older adults are diagnosed with type 1 diabetes, and the Incidence section reports substantially lower incidence in Asia than in Europe and North America. The Conclusions attribute the growing number of older adults with type 1 diabetes partly to improved survival and new-onset disease; they do not establish that diagnoses in older adulthood are increasing over time. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    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 (84) and/or osteopenia (85).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [84] Feng, 2022, Prevalence and risk factors of sarcopenia in patients with diabetes: a meta-analysis, J Clin Endocrinol Metab source
    • cites [85] Li, 2024, Type 2 diabetes and bone mineral density: a meta-analysis and systematic review, Medicine (Baltimore) source

      The Discussion reports lower bone mineral density and increased osteoporosis risk in people with type 2 diabetes, which supports the bone-health concern attached to citation (85). It does not specifically establish osteopenia in the aging population. The muscle-related claims are attached to citation (84), not this source. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation
    § Abstract

    The Look AHEAD intensive lifestyle intervention produced 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.

    “the intensive lifestyle intervention produced 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”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [98] Wing, 2013, Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes, N Engl J Med source

      The Results sections on weight, waist circumference and fitness, and on cardiovascular disease risk factors, report improvements in weight, waist circumference, fitness, A1c and systolic blood pressure, along with lower use of antihypertensive medications, statins and insulin. The risk-factor passage says all measured factors except LDL cholesterol improved initially, but our copy does not specifically identify HDL cholesterol or document an increase in it. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    Pioglitazone has low risk for hypoglycemia but carries risks for heart failure, fluid retention, weight gain, osteoporosis, and/or macular edema.

    “Pioglitazone has low risk for hypoglycemia but should be used cautiously and in select individuals due to risks for heart failure, fluid retention, weight gain, osteoporosis, and/or macular edema”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [118] Schwartz, 2015, Effects of TZD use and discontinuation on fracture rates in ACCORD bone study, J Clin Endocrinol Metab source

      The Discussion (page not provided) reports increased bone loss with pioglitazone in some groups and cites increased fracture risk with pioglitazone, supporting the skeletal-risk portion of the claim. The paper does not establish low hypoglycemia risk or address heart failure, fluid retention, weight gain, or macular edema as pioglitazone risks. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [119] Billington, 2015, The effect of thiazolidinediones on bone mineral density and bone turnover: systematic review and meta-analysis, Diabetologia source

      The Study characteristics section reports that thiazolidinediones reduced bone mineral density and that analyses restricted to pioglitazone trials were similar; the Discussion advises caution in patients at high fracture risk. This supports a skeletal-risk concern, though the paper does not establish osteoporosis as a diagnosed outcome. Our copy does not support the claims about low hypoglycemia risk, heart failure, fluid retention, weight gain, or macular edema. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation
    § Abstract

    Individuals with complex or intermediate health may not derive benefit from intensive glucose lowering and are more likely to experience serious adverse effects of treatment, such as hypoglycemia.

    “These individuals may not only not derive benefit from intensive glucose lowering but are also more likely to experience serious adverse effects of treatment, such as hypoglycemia”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [73] 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 provided) says very intensive glucose control appears to offer no significant cardiovascular benefit in older patients, especially those with or at high risk for heart disease, and that intensive treatment may increase hypoglycemia risk. It does not establish those findings specifically for people classified as having complex or intermediate health. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    Elevated glucose levels (>180 mg/dL [>10 mmol/L]) increase risks of dehydration, weakness, infection, poor wound healing, and hyperglycemic crises.

    “elevated glucose levels (>180 mg/dL [>10 mmol/L]) increase risks of dehydration, weakness, infection, poor wound healing, and hyperglycemic crises”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [74] Lipska, 2024, Risk of infection in older adults with type 2 diabetes with relaxed glycemic control, Diabetes Care source

      The Conclusions (page not supplied) state that hyperglycemia increases susceptibility to infection, and report higher hospitalization risk for skin, soft-tissue, and bone infections at HbA1c 8% to <9%. The paper does not establish a glucose threshold of >180 mg/dL or address dehydration, weakness, poor wound healing, or hyperglycemic crises; it also finds no significant increase in hospitalization for most infections at relaxed glycemic-control levels. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation
    § Abstract

    The benefits of a structured physical activity program in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty.

    “The benefits of a structured physical activity 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”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [95] 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 (Major mobility disability; page unavailable) show that the structured physical activity group had less major mobility disability than the health education group. Results (Intervention adherence; page unavailable) show more moderate activity, but do not establish reduced sedentary time; the paper also does not report a reduction in frailty. Participants were sedentary older adults with physical limitations, not explicitly identified as frail. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    Some older individuals may have developed diabetes years earlier and have significant complications, others are newly diagnosed and may have had years of undiagnosed diabetes with resultant complications, and still other older adults may have truly recent-onset disease with few or no complications.

    “Some older individuals may have developed diabetes years earlier and have significant complications, others are newly diagnosed and may have had years of undiagnosed diabetes with resultant complications, and still, other older adults may have truly recent-onset disease with few or no complications (57).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [57] Selvin, 2006, The burden and treatment of diabetes in elderly individuals in the U.S, Diabetes Care source

      Split into 3 atoms — 1 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation
    § Abstract

    The Look AHEAD lifestyle intervention produced benefits on aging-relevant outcomes, including reductions in multimorbidity, improved physical function, and enhanced quality of life.

    “The lifestyle intervention also produced benefits on aging-relevant outcomes, including reductions in multimorbidity, improved physical function, and enhanced quality of life”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [103] Houston, 2018, Physical function following a long-term lifestyle intervention among middle aged and older adults with type 2 diabetes: the Look AHEAD study, J Gerontol A Biol Sci Med Sci source

      The Results and Discussion (pages not provided) report modest, significant improvements in gait speed and other physical-function measures after the Look AHEAD intervention. The paper does not report reductions in multimorbidity or an improvement in quality of life; its mention of the SF-36 describes a measure of health status, not a quality-of-life result. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [104] Simpson, 2020, Impact of multidomain lifestyle intervention on frailty through the lens of deficit accumulation in adults with type 2 diabetes mellitus, J Gerontol A Biol Sci Med Sci source
    • cites [105] Espeland, 2020, Impact of an 8-year intensive lifestyle intervention on an index of multimorbidity, J Am Geriatr Soc source

      The Results and Discussion (page unavailable) report that Look AHEAD’s intensive lifestyle intervention slowed the increase in a multimorbidity index compared with diabetes support and education. The paper mentions fitness and cites a separate quality-of-life study, but does not report improved physical function or enhanced quality of life as findings of this analysis. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [106] Gregg, 2018, Impact of intensive lifestyle intervention on disability-free life expectancy: the Look AHEAD study, Diabetes Care source

      The Incidence of Physical Disability section reports a lower rate of moderate or severe disability in the intervention group, and the Conclusions describe improved physical fitness and reported quality-of-life benefits, particularly mobility and perceived health. The paper does not report a reduction in multimorbidity, so that part of the claim is unsupported. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    Deintensification of glucose-lowering plans can be achieved by either lowering the dose or discontinuing some medications, as long as individualized glycemic goals are maintained.

    “Deintensification of glucose-lowering plans can be achieved by either lowering the dose or discontinuing some medications, as long as individualized glycemic goals are maintained”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [114] Seidu, 2019, Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes, Diabetes Obes Metab source

      The review identifies dose reduction and discontinuation as deintensification approaches (Section 3.3, p. 4). It reports that most studies with relevant data found no deterioration in HbA1c after deintensification (Section 4.1, p. 9), but does not establish that individualized glycaemic goals were maintained; it says evidence on achieving safe individual targets is limited (Section 4.4, p. 10). (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [115] Weiner, 2019, Use and discontinuation of insulin treatment among adults aged 75 to 79 years with type 2 diabetes, JAMA Intern Med source

      The Discussion (page unavailable in our copy) describes insulin discontinuation and regimen simplification, including moving from long- and short-acting insulin to long-acting insulin alone. It also discusses individualized glycemic treatment in older adults, but does not describe lowering medication doses or establish that individualized glycemic goals were maintained after deintensification. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    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”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [92] Liu, 2017, Pilot study of the Mini Nutritional Assessment on predicting outcomes in older adults with type 2 diabetes, Geriatr Gerontol Int source
    • cites [93] Malara, 2014, Relationship between cognitive impairment and nutritional assessment on functional status in Calabrian long-term-care, Clin Interv Aging source

      The Results report an association between nutritional status and cognition, the Discussion links malnutrition with greater ADL impairment, and the Introduction describes reduced quality of life. The paper does not report grip strength or lower-limb physical performance, so those parts of the claim are unsupported. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [94] 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, personal care and daily-task difficulties, and lower health-related quality of life in older adults with type 2 diabetes. They do not establish an association with reduced grip strength: the reported handgrip correlation is .142 and is not marked significant. The paper also does not report a nutritional-status association with cognition, and its findings are limited to this study population. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

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

    “Due in part to the success of modern diabetes management, people with type 1 diabetes are living longer, and the population of people over 65 years with type 1 diabetes is growing (154–156).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [154] Livingstone, 2015, Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010, JAMA source

      The Discussion compares the Scottish cohort with earlier studies and reports a higher estimated life expectancy, but says it cannot directly assess whether life expectancy has improved because it lacks historical data for the same population. The paper notes advances in treatment, but does not establish that they caused longer survival or that the population over 65 with type 1 diabetes is growing. No page numbers are available in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [155] 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 and diabetes management as potential contributors. The paper does not establish that the population of people over 65 with type 1 diabetes is growing. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [156] Bullard, 2018, Prevalence of diagnosed diabetes in adults by diabetes type - United States, 2016, MMWR Morb Mortal Wkly Rep source

      The Discussion (page unavailable) says it is not known whether the reported prevalence trend differs for type 1 diabetes. The paper estimates prevalence from a single 2016 survey; its age-group results do not establish that people with type 1 diabetes are living longer, that their population over 65 is growing, or that modern management caused either change. Searched for survival, longevity, management, and older-adult trends. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    DPP-4 inhibitors are relatively weak glucose-lowering agents and do not reduce cardiovascular or kidney disease risks like GLP-1 RAs and SGLT2 inhibitors.

    “DPP-4 inhibitors are relatively weak glucose-lowering agents and do not reduce cardiovascular or kidney disease risks like GLP-1 RAs and SGLT2 inhibitors”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [130] 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-4i discussion (page unavailable) reports no reduction in cardiovascular outcomes versus placebo, while the Abstract reports cardiovascular benefits for GLP-1 RAs and SGLT-2 inhibitors. The paper does not establish that DPP-4 inhibitors are relatively weak glucose-lowering agents or compare the drug classes’ effects on kidney disease risk (searched: glycemic efficacy and kidney/renal outcomes). (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    SGLT2 inhibitors may cause clinically significant volume depletion, for which older adults are at greater risk.

    “SGLT2 inhibitors may cause clinically significant volume depletion, for which older adults are at greater risk”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [143] Scheen, 2023, Efficacy and safety profile of SGLT2 inhibitors in the elderly: how is the benefit/risk balance?, Diabetes Metab source

  • May combine two claims.

    Premisecitation
    § Abstract

    Sulfonylureas are associated with hypoglycemia, bone loss, and fracture risk.

    “Sulfonylureas are associated with hypoglycemia, bone loss (121), and fracture risk (122)”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [121] 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 [122] Napoli, 2014, Fracture risk in diabetic elderly men: the MrOS study, Diabetologia source

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

    Premisecitation
    § Abstract

    An individual has the right to refuse testing and treatment, whereas health care professionals may consider withdrawing treatment and limiting diagnostic testing, including a reduction in the frequency of blood glucose monitoring.

    “An individual has the right to refuse testing and treatment, whereas health care professionals may consider withdrawing treatment and limiting diagnostic testing, including a reduction in the frequency of blood glucose monitoring (175,176).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [175] Ford-Dunn, 2006, Management of diabetes during the last days of life: attitudes of consultant diabetologists and consultant palliative care physicians in the UK, Palliat Med source
    • cites [176] Petrillo, 2018, Hypoglycemia in hospice patients with type 2 diabetes in a national sample of nursing homes, JAMA Intern Med source

      The opening section reports recommendations to relax glycemic targets and eventually discontinue diabetes medications as patients near death, supporting the treatment-withdrawal portion of the claim. It does not address an individual's right to refuse testing or treatment, or recommend limiting diagnostic testing or reducing the frequency of glucose monitoring. The Results section reports testing frequencies but does not present a recommendation to reduce them; page numbers are unavailable in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    Weight loss achieved with use of GLP-1 RAs and the GIP/GLP-1 RA is beneficial for obstructive sleep apnea, knee osteoarthritis, and metabolic dysfunction-associated steatohepatitis (MASH).

    “Weight loss achieved with use of GLP-1 RAs and the GIP/GLP-1 RA is also beneficial for obstructive sleep apnea (132), knee osteoarthritis (133), and metabolic dysfunction–associated steatohepatitis (MASH) (134–136).”
    Quote in the paperNot a substantial claim2 of 5 sources checked
    • cites [132] Malhotra, 2024, Tirzepatide for the treatment of obstructive sleep apnea and obesity, N Engl J Med source
    • cites [133] Bliddal, 2024, Once-weekly semaglutide in persons with obesity and knee osteoarthritis, N Engl J Med source
    • cites [134] Loomba, 2024, Tirzepatide for metabolic dysfunction-associated steatohepatitis with liver fibrosis, N Engl J Med source
    • cites [135] Sanyal, 2025, Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis, N Engl J Med source
    • cites [136] Newsome, 2021, A placebo-controlled trial of subcutaneous semaglutide in nonalcoholic steatohepatitis, N Engl J Med source

      The Results (p. 2) report both greater weight loss and more frequent NASH resolution with the GLP-1 receptor agonist semaglutide than with placebo. The Discussion (p. 11) describes weight loss as a potential indirect mechanism, but the trial does not establish that weight loss caused the NASH benefit or evaluate a dual GIP/GLP-1 agonist. This citation supports the MASH-related part of the sentence, not its separately cited sleep-apnea or osteoarthritis claims. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    Euglycemic diabetic ketoacidosis (DKA) is a rare but potentially serious phenomenon associated with treatment with SGLT2 inhibitors, especially in those with multimorbidity who reside in post-acute and long-term care (PALTC) settings, with infection being the most common trigger.

    “Euglycemic diabetic ketoacidosis (DKA) is a rare but potentially serious phenomenon associated with treatment with SGLT2 inhibitors, especially in those with multimorbidity who reside in post-acute and long-term care (PALTC) settings, with infection being the most common trigger”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [145] Krepostman, 2021, Lower urinary tract symptoms should be queried when initiating sodium glucose co-transporter 2 inhibitors, Kidney360 source
    • cites [147] Ata, 2021, SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort, Sci Rep source

      The Discussion calls SGLT2 inhibitor–associated EuDKA rare, and the Conclusion reports that infection primarily triggered DKA in the cohort, including EuDKA. The Results (Precipitating factors; page unavailable) specify that infection was more common in hyperglycemic DKA than EuDKA. The study examined patients admitted to three tertiary-care hospitals, not PALTC residents; its suggestion that people with more complicated diabetes may be prone to EuDKA does not establish particular risk in PALTC residents with multimorbidity. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

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

    “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”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] 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. Searches for social support, access to long-term services, and functional dependency found no passage connecting those factors to the claimed outcomes. The paper's discussion of functional disability does not establish the attributed relationship. (LLM, conf=0.75)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation
    § Abstract

    Individualization of health care is important for all people with diabetes; however, practical guidance for feasible and sustainable care delivery is needed for health care professionals, PALTC staff, and care partners.

    “Individualization of health care is important for all people with diabetes; however, practical guidance for feasible and sustainable care delivery is needed for health care professionals, PALTC staff, and care partners (163,164).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [163] Munshi, 2016, Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association, Diabetes Care source

      The General Approach to Care and Integration of Diabetes Management Into LTC Facilities sections support individualized diabetes care and practical guidance for clinical and LTC staff. The paper focuses on older adults in long-term care, rather than all people with diabetes, and does not expressly call for feasible and sustainable guidance for care partners. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [164] Sloane, 2021, Individualizing diabetes care in older persons with multimorbidity, J Am Med Dir Assoc source

  • May combine two claims.

    Premisecitation
    § Abstract

    Meglitinides (repaglinide and nateglinide) increase the risk of hypoglycemia and fracture risk.

    “meglitinides (repaglinide and nateglinide) increase the risk of hypoglycemia and fracture risk”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [123] Zhang, 2021, Effects of anti-diabetic drugs on fracture risk: a systematic review and network meta-analysis, Front Endocrinol (Lausanne) source

      The Results (‘Others’; page unavailable) report a higher fracture-risk estimate for nateglinide versus placebo (RR 1.35), but its confidence interval (0.24–7.55) includes no increase; the Conclusions accordingly say it may increase risk. The copy does not establish increased fracture risk for repaglinide or increased hypoglycemia risk for either meglitinide. The Discussion’s reference to hypoglycemic episodes concerns sulfonylureas, not meglitinides. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [124] Wang, 2022, Unmasking fracture risk in type 2 diabetes: the association of longitudinal glycemic hemoglobin level and medications, J Clin Endocrinol Metab source

  • May combine two claims.

    Premisecitation
    § Abstract

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

    “Nevertheless, a feasibility study in PALTC facilities showed that CGM can be useful in older adults with diabetes, although it requires substantial staff training (158).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [158] 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 say CGM was feasible and useful for detecting hypoglycemia in older people receiving home care. The study was not conducted in PALTC facilities. The Abstract (Results) attributes extensive personnel training to the MMSE survey, not CGM; the Discussion mentions CGM training as an issue to address but does not say it requires substantial training. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

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

    “these transitions can lead to discontinuity in goals of care, errors in dosing, and changes in nutrition and activity”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [153] Davidson, 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 provided) discusses aligning diabetes management with residents’ goals of care, but does not say that transitions disrupt those goals. Searches for transitions, dosing errors, and changes in nutrition or activity found no passage in our copy addressing those effects. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Abstract

    A recent RCT in PALTC 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 RCT in PALTC 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 paperNot a substantial claim1 of 1 sources checked
    • cites [162] 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
    § Abstract

    GLP-1 RAs and the GIP/GLP-1 RA tirzepatide are injectable agents (except oral semaglutide) that require visual, motor, and cognitive skills for appropriate administration, although most have a weekly dosing schedule.

    “These drugs are injectable agents (with the exception of oral semaglutide) (137), which require visual, motor, and cognitive skills for appropriate administration, although most have a weekly dosing schedule.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [137] Husain, 2019, Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes, N Engl J Med source

  • May combine two claims.

    Premisecitation
    § Abstract

    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 (113,174) and is clearly relevant for palliative care.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [113] 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 can cause harm, including hypoglycemia, and argues for greater attention to deintensifying glycemic therapy in frail patients. But this study measured how often therapy was reduced, not the safety or efficacy of deintensification protocols; it did not evaluate blood-pressure deintensification. The copy provides section labels but no page numbers. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [174] 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, supporting the blood-pressure portion of the claim. The Subgroup Analyses report significantly more adverse events after reduction, and the Discussion says the trial could not establish longer-term benefits or harms. This paper therefore contributes short-term efficacy evidence, but does not establish the safety of deintensification protocols more broadly. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation
    § Abstract

    The goal of palliative medicine is to promote comfort, symptom management and prevention (pain, hypoglycemia, hyperglycemia, and dehydration), and preservation of dignity and quality of life in the setting of limited life expectancy.

    “The goal of palliative medicine is to promote comfort, symptom management and prevention (pain, hypoglycemia, hyperglycemia, and dehydration), and preservation of dignity and quality of life in the setting of limited life expectancy (169,170).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [169] Sinclair, 2012, Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes, J Am Med Dir Assoc source

      The Diabetes in Care Homes consensus statements (indexed under Hypoglycemia; page unavailable) call for preventing hypoglycemia, recognizing and managing pain, and introducing timely end-of-life care. They do not state the broader goal attributed to palliative medicine, including preservation of dignity and quality of life or prevention of dehydration. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [170] Sharma, 2019, Management of diabetes mellitus in adults at the end of life: a review of recent literature and guidelines, J Palliat Med source

  • May combine two claims.

    Premisecitation
    § Abstract

    In the same RCT, there were no differences in TIR, time below range, or mean glucose levels between real-time CGM and BGM.

    “There were no differences in TIR, time below range, or mean glucose levels (162).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [162] 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
    § Abstract

    In the ORACL trial in 30 older adults (mean age 67 years) with type 1 diabetes, an automated insulin delivery (AID) strategy was associated with significant improvements in time in range (TIR), as well as modest improvements in hypoglycemia, compared with sensor-augmented pump therapy.

    “The Older Adult Closed Loop (ORACL) trial in 30 older adults (mean age 67 years) with type 1 diabetes found that an automated insulin delivery (AID) strategy was associated with significant improvements in time in range (TIR), as well as modest improvements in hypoglycemia, compared with sensor-augmented pump therapy (52).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] McAuley, 2022, Closed-loop insulin delivery versus sensor-augmented pump therapy in older adults with type 1 diabetes (ORACL): a randomized, crossover trial, Diabetes Care source

  • May combine two claims.

    Premisecitation
    § Abstract

    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 (2,8).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] Centers for Disease Control and Prevention . National Diabetes Statistics Report,2024. Accessed 28 August 2025. Available from https://www.cdc.gov/diabetes/php/data-research/index.html

      Not checked in the free run.

    • cites [8] Pilla, 2023 source

  • May combine two claims.

    Premisenone given
    § Abstract

    Both studies enrolled older individuals whose blood glucose was relatively well managed at baseline (mean A1C ∼7.4%).

    “Both studies enrolled older individuals whose blood glucose was relatively well managed at baseline (mean A1C ∼7.4%).”
    Quote in the paperNot a substantial claim

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

    Premisenone given
    § Abstract

    These intensive treatment plans included extensive use of insulin and minimal use of GLP-1 RAs, and they preceded the availability of SGLT2 inhibitors.

    “However, these intensive treatment plans included extensive use of insulin and minimal use of GLP-1 RAs, and they preceded the availability of SGLT2 inhibitors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Abstract

    Hypoglycemia 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 paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Abstract

    The 4Ms framework was developed by the Institute for Healthcare Improvement as an evidence-based framework for age-friendly health care and 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 paperSubstantial claim0 of 1 sources checked
    • cites [12] Cacchione, 2020, Age-friendly health systems: the 4Ms framework, Clin Nurs Res source

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

    Premisenone given
    § Abstract

    Geriatric syndromes, hypoglycemia, and polypharmacy may affect diabetes management and diminish quality of life in older adults with diabetes.

    “Screen at least annually for geriatric syndromes (e.g., cognitive impairment, depression, urinary incontinence, falls, persistent pain, and frailty), hypoglycemia, and polypharmacy in older adults with diabetes, as they may affect diabetes management and diminish quality of life. B”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Abstract

    Conditions affecting red blood cell turnover that are common in older adults include kidney failure, recent significant blood loss, and erythropoietin therapy.

    “Conditions affecting red blood cell turnover that are common in older adults include kidney failure, recent significant blood loss, and erythropoietin therapy.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [65] National Glycohemoglobin Standardization Program . Factors that interfere with HbA1c test results. Accessed 28 August 2025. Available from https://ngsp.org/factors.asp

      Not checked in the free run.

  • May combine two claims.

    Premisenone given
    § Abstract

    Older adults with diabetes have higher rates of cognitive impairment and dementia, leading to difficulties in performing complex self-care activities.

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

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given
    § Abstract

    The general care principles discussed here apply to all individuals with complex health needs and are not limited to older adults.

    “Importantly, the general care principles discussed here apply to all individuals with complex health needs and are not limited to older adults.”
    Quote in the paperNot a substantial claim

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

    Premisenone given
    § Abstract

    Type 2 diabetes predominates in the older population.

    “While type 2 diabetes predominates in the older population (as in the younger population), improvements in insulin delivery, technology, and care over the last few decades have led to increasing numbers of people with childhood and adult-onset type 1 diabetes surviving and thriving into their later decades.”
    Quote in the paperNot a substantial claim

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

    Premisecitation
    § Abstract

    The key elements of the 4Ms approach are Mentation, Medications, Mobility, and What Matters Most, with each element affecting the others.

    “The key elements of this approach are Mentation, Medications, Mobility, and What Matters Most, with each element affecting the others (12).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Cacchione, 2020, Age-friendly health systems: the 4Ms framework, Clin Nurs Res source

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

    Premisenone given
    § Abstract

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

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

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given
    § Abstract

    Improvements in insulin delivery, technology, and care over the last few decades have led to increasing numbers of people with childhood and adult-onset type 1 diabetes surviving and thriving into their later decades.

    “While type 2 diabetes predominates in the older population (as in the younger population), improvements in insulin delivery, technology, and care over the last few decades have led to increasing numbers of people with childhood and adult-onset type 1 diabetes surviving and thriving into their later decades.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Abstract

    Several assessment tools are available to screen for cognitive impairment, such as the Mini-Cog, Mini-Mental State Examination, and Montreal Cognitive Assessment, which may help identify individuals with dementia or those requiring neuropsychological evaluation when dementia is suspected.

    “Several assessment tools are available to screen for cognitive impairment (29,30), such as the Mini-Cog (31), Mini-Mental State Examination (32), and the Montreal Cognitive Assessment (33), which may help identify individuals with dementia (who are experiencing memory loss, a decrease in executive function, and declines in their basic and instrumental activities of daily living) or those requiring”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [29] National Institute on Aging . Assessing cognitive impairment in older patients. Accessed 28 August 2025. Available from https://www.nia.nih.gov/health/assessing-cognitive-impairment-older-patients

      Not checked in the free run.

    • cites [30] Alzheimer’s Association, Cognitive assessment.

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

    • cites [31] Borson, 2003, The Mini-Cog as a screen for dementia: validation in a population-based sample, J Am Geriatr Soc source
    • cites [32] Folstein, 1975, “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician, J Psychiatr Res source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given
    § Abstract

    Lipid-lowering therapy and antiplatelet agents may benefit those with life expectancies at least equal to the time frame of primary prevention or secondary intervention trials.

    “Lipid-lowering therapy and antiplatelet agents may benefit those with life expectancies at least equal to the time frame of primary prevention or secondary intervention trials. A”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given
    § Abstract

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

    “To avoid DKA, older adults with type 1 diabetes need some form of basal insulin even when they are unable to ingest meals.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Insulin is an essential life-preserving therapy for people with type 1 diabetes.

  • May combine two claims.

    Premisecitation
    § Abstract

    CGM 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 (49)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] 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

  • May combine two claims.

    Premisecitation
    § Abstract

    Using CGM can provide useful and more prompt information on hypoglycemia as well as time spent in severe hyperglycemia in older adults with diabetes in PALTC facilities.

    “Using CGM can provide useful and more prompt information on hypoglycemia as well as time spent in severe hyperglycemia (as noted in a study of 65 residents in 8 long-term facilities) in this population (161).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [161] Munshi, 2025, Excessive burden of hyperglycemia along with hypoglycemia in long-term care facilities identified by continuous glucose monitoring, J Am Med Dir Assoc source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given
    § Abstract

    In older people with type 1 diabetes, administration of insulin may become more difficult as complications, cognitive impairment, and functional impairment arise.

    “In older people with type 1 diabetes, administration of insulin may become more difficult as complications, cognitive impairment, and functional impairment arise.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § Abstract

    Diabetes health care professionals are well positioned to support people with diabetes in advance care planning.

    “Diabetes health care professionals are well positioned to support people with diabetes in advance care planning.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Abstract

    SGLT2 inhibitors are generally well tolerated among older adults, although thoughtful selection is needed to avoid adverse effects in individuals at elevated risk.

    “SGLT2 inhibitors are generally well tolerated among older adults, although thoughtful selection is needed to avoid adverse effects in individuals at elevated risk”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [142] Lunati, 2022, SGLT2-inhibitors are effective and safe in the elderly: the SOLD study, Pharmacol Res source

  • May combine two claims.

    Premisecitation
    § Abstract

    Glyburide is a longer-acting sulfonylurea with multiple active metabolites and should be avoided in older adults due to its hypoglycemia risk.

    “Glyburide is a longer-acting sulfonylurea with multiple active metabolites and should be avoided in older adults due to its hypoglycemia risk”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [126] American Geriatrics Society 2015, 2015, updated Beers Criteria for potentially inappropriate medication use in older adults, J Am Geriatr Soc

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Abstract

    They have a disproportionately high number of health conditions that can increase hypoglycemia risk: impaired cognitive and renal function, slowed hormonal regulation and counter-regulation, suboptimal hydration, variable appetite and nutritional intake, requirement for feeding assistance, polypharmacy, and slowed intestinal absorption.

    “They have a disproportionately high number of health conditions that can increase hypoglycemia risk: impaired cognitive and renal function, slowed hormonal regulation and counter-regulation, suboptimal hydration, variable appetite and nutritional intake, requirement for feeding assistance, polypharmacy, and slowed intestinal absorption (166).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [166] Migdal, 2011, Update on diabetes in the elderly and in nursing home residents, J Am Med Dir Assoc source

  • Classified as probably not a substantial claim.

    Premisecitation
    § Abstract

    Different categories have been proposed for diabetes management in those at the end of life.

    “Different categories have been proposed for diabetes management in those at the end of life (77).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [77] Sinclair, 2013, International Diabetes Federation (IDF) Global Guideline for Managing Older People with Type 2 Diabetes, International Diabetes Federation

      Not checked in the free run.

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

    Interpretationcitation
    § Abstract

    Many recommendations in this section 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 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 (157).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [157] 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

  • Classified as probably not a substantial claim.

    Premisecitation
    § Abstract

    Health care professionals can assist people with diabetes in clarifying and documenting their values, preferences, and goals for care in an advanced care plan.

    “Health care professionals can assist people with diabetes in clarifying and documenting their values, preferences, and goals for care in an advanced care plan (172).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [172] Dunning, 2018, Palliative and end of life care of people with diabetes: issues, challenges and strategies, Diabetes Res Clin Pract source
65 of 65

  • The paper relies on this without support.

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

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

  • The paper relies on this without support.

    Management of blood pressure and cholesterol lowering with statins is 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.

    Benefits of CGM use in older individuals not treated with insulin include reducing hypoglycemia and improving other glycemic outcomes.

    “Additionally, benefits have been shown with CGM use in older individuals not treated with insulin, particularly for reducing hypoglycemia and improving other glycemic outcomes.”

  • The paper relies on this without support.

    It may take longer for older adults to learn and gain facility with new technology.

    “Importantly, it may take longer for older adults to learn and gain facility with new technology and it may be beneficial to engage their caregivers in the process.”

  • The paper relies on this without support.

    CGM may be useful for glucose monitoring in older adults with physical and/or cognitive limitations who require surrogate monitoring and in those in long-term care settings.

    “CGM may also be useful for glucose monitoring in older adults with physical and/or cognitive limitations who require monitoring of blood glucose by a surrogate and in those who reside in group homes, assisted living facilities, or other post-acute long-term care settings.”

  • The paper relies on this without support.

    Hypoglycemia may be precipitated by acute illness and other stressful events such as trauma or surgery.

    “Hypoglycemia may also be precipitated by acute illness and other stressful events such as trauma or surgery.”

  • The paper relies on this without support.

    Life expectancy is affected by age, disease burden, and degrees of frailty and disability.

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

  • The paper relies on this without support.

    Limited time for medical visits and competing priorities can make implementation of these recommendations challenging.

    “Limited time for medical visits, and competing priorities such as acute problems or change in living situation or social support, can make implementation of these recommendations challenging.”

  • The paper relies on this without support.

    Older adults with very complex or poor health receive minimal benefit from stringent glycemic goals.

    “Older adults with very complex or poor health receive minimal benefit from stringent glycemic goals.”

  • The paper relies on this without support.

    Other older individuals with diabetes have little comorbidity and intact cognitive and physical functioning.

    “Other older individuals with diabetes have little comorbidity and intact cognitive and physical functioning.”

  • The paper relies on this without support.

    There are few long-term studies in older adults demonstrating the benefits of intensive glycemic, blood pressure, and lipid management.

    “There are few long-term studies in older adults demonstrating the benefits of intensive glycemic, blood pressure, and lipid management.”

  • The paper relies on this without support.

    Older adults with good functional status and without complications can be treated with therapeutic interventions and goals similar to those for younger adults with diabetes.

    “may be treated using therapeutic interventions and goals similar to those for younger adults with diabetes”

  • The paper relies on this without support.

    Diabetes is 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.

    Older adults are at high risk of polypharmacy and its adverse sequelae.

    “older adults, who are at high risk of polypharmacy and its adverse sequelae”

  • The paper relies on this without support.

    Older adults are often treated with multiple medications and live on fixed incomes.

    “older adults are often treated with multiple medications and live on fixed incomes”

  • The paper relies on this without support.

    High treatment burden is an indicator of potential overtreatment.

    “High treatment burden is another indicator of potential overtreatment.”

  • The paper relies on this without support.

    Metformin has a low risk for hypoglycemia and a simple administration profile.

    “Metformin is a good treatment option for glucose lowering in older adults with type 2 diabetes due to its low risk for hypoglycemia and simple administration profile”

  • The paper relies on this without support.

    Metformin is contraindicated in advanced kidney disease and should be used with caution in those with hypoperfusion, hypoxemia, and impaired hepatic function due to potential risk of lactic acidosis.

    “metformin is contraindicated in those with advanced kidney disease and should be used with caution in those with hypoperfusion, hypoxemia, and impaired hepatic function due to potential 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.

    “metformin can cause gastrointestinal side effects (this risk can be minimized through slow uptitration at initiation) and a reduction in appetite that can be problematic for some older adults”

  • The paper relies on this without support.

    Adverse effect risks of pioglitazone are reduced with lower doses and when it is used as part of combination therapy.

    “Adverse effect risks are reduced with lower doses of pioglitazone and when it is used as part of combination therapy.”

  • The paper relies on this without support.

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

    “Dipeptidyl peptidase 4 (DPP-4) inhibitors have few side effects and minimal risk of hypoglycemia”

  • The paper relies on this without support.

    Linagliptin does not require renal dose adjustment.

    “linagliptin does not require renal dose adjustment”

  • The paper relies on this without support.

    GLP-1 RAs and the GIP/GLP-1 RA tirzepatide are highly effective glucose-lowering medications with low risk for hypoglycemia and can be used in the setting of reduced eGFR, including during dialysis.

    “GLP-1 RAs and the GIP/GLP-1 RA tirzepatide are highly effective glucose-lowering medications with low risk for hypoglycemia and can be used in the setting of reduced eGFR, including during dialysis.”

  • The paper relies on this without support.

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

    “GLP-1 RAs may also be associated with nausea, vomiting, diarrhea, and/or constipation”

  • The paper relies on this without support.

    Excessive weight loss may lead to significant loss of muscle mass (sarcopenia) and bone density.

    “excessive weight loss, which may lead to significant loss of muscle mass (sarcopenia) and bone density”

  • The paper relies on this without support.

    SGLT2 inhibitors are administered orally, which may be convenient for older adults with diabetes.

    “SGLT2 inhibitors are administered orally, which may be convenient for older adults with diabetes.”

  • The paper relies on this without support.

    SGLT2 inhibitors are beneficial for people with heart failure and slow the progression of chronic kidney disease.

    “This class of agents has also been found to be beneficial for people with heart failure and to slow the progression of chronic kidney disease.”

  • The paper relies on this without support.

    The use of insulin therapy requires that individuals or their caregivers have good visual and motor skills and cognitive ability to manage insulin dosing and administration and to recognize and treat hypoglycemia.

    “The use of insulin therapy requires that individuals or their caregivers have good visual and motor skills and cognitive ability to manage insulin dosing and administration and to recognize and treat hypoglycemia.”

  • The paper relies on this without support.

    Age alone does not limit the utility of technology.

    “Age alone does not limit the utility of technology”

  • The paper relies on this without support.

    Multiple daily injections of insulin may be too complex for many older individuals with advanced diabetes complications, life-limiting coexisting chronic illnesses, cognitive or functional impairment, or limited functional status or social support.

    “Multiple daily injections of insulin may be too complex for many older individuals with advanced diabetes complications, life-limiting coexisting chronic illnesses, cognitive or functional impairment, or limited functional status or social support.”

  • The paper relies on this without support.

    The need for ongoing support of older adults becomes even greater when transitions to post-acute and long-term care become necessary.

    “The need for ongoing support of older adults becomes even greater when transitions to PALTC become necessary.”

  • The paper relies on this without support.

    Older adults in assisted living facilities may not have support to administer their own medications.

    “Older adults in assisted living facilities may not have support to administer their own medications”

  • The paper relies on this without support.

    Insulin is an essential life-preserving therapy for people with type 1 diabetes.

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

  • The paper relies on this without support.

    Staff in PALTC settings are less familiar with CGM devices, insulin pumps, or advanced insulin delivery devices.

    “unfortunately staff in these settings continue to be less familiar with CGM devices, insulin pumps, or advanced insulin delivery devices.”

  • The paper relies on this without support.

    Some staff may be less knowledgeable about the differences between type 1 and type 2 diabetes.

    “Some staff may be less knowledgeable about the differences between type 1 and type 2 diabetes.”

  • The paper relies on this without support.

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

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

  • The paper relies on this without support.

    The individual or their family may be more familiar with their current diabetes management plan than the staff or health care professionals.

    “In these instances, the individual or their family may be more familiar with their current diabetes management plan than the staff or health care professionals.”

  • The paper relies on this without support.

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

    “An older adult residing in a PALTC facility may have irregular and unpredictable meal consumption, undernutrition, diminished appetite, 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.

    In the PALTC setting, health care professionals are not required to evaluate individuals daily.

    “Another consideration for the PALTC setting is that unlike in the hospital setting, health care professionals are not required to evaluate individuals daily.”

  • 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 for acute medical problems or worsening of existing conditions.

    “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 for acute medical problems or worsening of existing conditions.”

  • The paper relies on this without support.

    Individuals may have poorly managed glucose levels or wide excursions without the practitioner being notified.

    “Although in practice some individuals may be seen more frequently, individuals may have poorly managed glucose levels or wide excursions without the practitioner being notified.”
43 of 43

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.

  • Two ADL impairments qualify for two different health-status categories

    Major

    Table 13.2 lists two or more ADL impairments as sufficient for both the complex/intermediate and very complex/poor health categories. The categories carry different glycemic guidance: an A1C goal below 8.0% versus avoiding reliance on A1C, so the table does not consistently classify a person meeting that criterion.

1 of 1

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 (2025-12-08). 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 2025-12-08

1 of 1

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 4

  1. Laiteerapong, Diabetes in America
  2. Alzheimer’s Association, Cognitive assessment.
  3. Sinclair, 2013, International Diabetes Federation (IDF) Global Guideline for Managing Older People with Type 2 Diabetes, International Diabetes Federation
  4. American Geriatrics Society 2015, 2015, updated Beers Criteria for potentially inappropriate medication use in older adults, J Am Geriatr Soc, 63, 2227

Cited by

Sorted by citations

Authors
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., Echouffo-Tcheugui, J. B., Everett, B. M., Garg, R., Laffel, L. M., Lal, R., Matfin, G., Napoli, N., Neumiller, J. J., Pandya, N., Pekas, E. J., Peters, A. L., Pilla, S. J., Romeo, G. R., Rosas, S. E., Segal, A. R., Szmuilowicz, E. D., & ElSayed, N. A.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2025-12-08
Volume
49
Issue
Supplement_1
Pages
S277-S296
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc26-s013
PMC
PMC12690186
OpenAlex
W4417121417
Semantic Scholar
7bd6f4011b0931a29af1762be10d9a5571d58eff
Cited by
87
References
176
Citations by year
2026: 87
FWCI
12.04
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
diabetes in older adults, diabetes management, clinical guidelines, quality of care, treatment goals, level of evidence
MeSH terms
Aged, Diabetes Mellitus, Humans, United States, 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.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review