In its annual update of standards for diabetes care, the American Diabetes Association makes several key changes for the diverse population of older adults.
For Medicare beneficiaries on any type of insulin, Recommendation 13.6 is now aligned with revised CMS rules allowing continuous glucose monitoring. Three recommendations (13.8a, 13.8b, and 13.8c) now highlight heterogeneous treatment goals for older adults, especially those with intermediate or complex health conditions who need to personalize glycemic goals.
Avoiding hypoglycemia is the goal of modifications to Recommendations 13.16a–13.16d, particularly for insulin, sulfonylureas, meglitinides, and other hypoglycemia-causing agents. “These recommendations also suggest switching to classes of glucose-lowering medications with a lower risk of hypoglycemia to meet individualized glycemic goals,” the authors write. “In addition, treatment plans for older adults with diabetes and other comorbidities (e.g., atherosclerotic cardiovascular disease, heart failure, and/or chronic kidney disease) should include agents that reduce cardiorenal risk, regardless of glycemia.”