ABSTRACT
Diabetes is a difficult public health problem because of its pathophysiological characteristics: its few symptoms are easily treated early in the disease, but as it progresses, the associated vascular disease and neurological and other complications lead to excess morbidity and mortality. Diabetes is associated with risks of atherosclerotic disease, microvscular complications, related and unrelated comorbidities, multiple impairments, and distal outcomes. Clinically, that means that older adults with diabetes have tremendous clinical complexity, multiple comorbidities, and, often, geriatric conditions and disabilities. The key characteristics of older adults with diabetes—heterogeneity, multimorbidity, and physiological complexity—have major implications for management of diabetes. Care for diabetes is expensive, and most of the expense is due to management of diabetic complications: atherosclerotic disease, retinal disease, and renal failure. The chronic medical management of diabetes—control of hypertension, cholesterol and hyperglycemia, and screening for complications—is suboptimal among adults of all ages with diabetes.
