INTRODUCTION

Diabetes mellitus (DM) is a dominant chronic disease of older adults in the United States as well as in many other countries of the world. The prevalence of DM in the future is only expected to grow with the increase in the population of older adults, the prevalence of obesity, and physical inactivity. Clinicians will be faced with many unique challenges when caring for this older diabetic population. The clinician's major challenges are 1) to avoid symptoms and complications of hyper- and hypoglycemia, 2) to minimize or delay micro- and macrovascular complications, if possible, and 3) to maximize daily functioning. Underlying these challenges is the realization that the geriatric population is a heterogeneous one. Goals of care and treatment decisions may vary. These may depend less on the chronological age of the patient, although issues of life expectancy must be considered especially in the very old, but more so on the patient's functional abilities and on other comorbidities or coexisting geriatric syndromes. This chapter will focus on specific aspects of diabetes care in the older adult.

EPIDEMIOLOGY

An estimated 10.3 million people, or 20.9% of those 60 years of age or older, in the United States are afflicted with DM, the majority of whom have type 2 disease. Approximately half of Americans with diabetes are 60 years of age or older with an approximately even split between men and women. DM is more prevalent in minority groups.