ABSTRACT
Diabetes mellitus is a common chronic disease among older adults. It is present in up to 18% of persons older than 65, comprising more than 40% of all persons with diabetes in the United States (1,2). Because such a sizable proportion of diabetes patients are 65 and older, it is important to consider both the similarities and differences between older and younger diabetes patients. In both groups, type 2 diabetes is the most common form of diabetes, and the macrovascular complications of diabetes are the major causes of morbidity and mortality in all diabetes patients. As with younger diabetes patients, most older patients with diabetes are highly functional and active, and deserve the same attention to diabetes management as younger patients. However, older patients are different in several important ways: (a) Because of their numbers and prevalence of complications, older patients have a large influence on health service utilization and costs. Therefore, even minor successes of management interventions in preventing or mitigating complications can potentially have a large effect on the health status of the older population and health care utilization, (b) Older patients are heterogeneous, often with comorbidities and disabilities that must be considered for their influence on the patient's clinical status; therefore, the physician must perform a detailed evaluation to determine appropriate management goals and inventions, (c) Some older patients may be more symptomatic from hyperglycemia than younger patients, but they are also more prone to complications of treatment, (d) Special evaluation and treatment goals must be devised for the "frail" elderly. Table 1 summarizes some of these differences.
