ENDO 2019—New guidelines for older adults with DM

  • Tara Haelle
  • Conference Reports
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  • New guidelines from the Endocrine Society for treatment of diabetes mellitus (DM) in adults age 65 and older recommend simplifying medication regimens and personalizing glycemic targets to improve compliance and reduce treatment-related complications. 
  • Use lifestyle modification for first-line treatment for hyperglycemia in ambulatory patients.
  • Limit simple sugars preferred over restrictive diets to manage nutrition.  
  • Employ shared decision-making to individualize screening and diabetes/comorbidities management.
  • Guidelines address considerations for neuropathy, fall risk, lower-extremity problems, chronic kidney disease, hypertension, hyperlipidemia, and congestive heart failure.


  • Screen all adults age 65+ with fasting plasma glucose and/or HbA1c; repeat every 2 years following normal results.
    • Consider potential inaccuracy of HbA1c with comorbidities or high risk.
    • Administer 2-hour glucose post-oral glucose tolerance test in those meeting prediabetes criteria. 
  • Recommended in adults 65+ with diabetes:
    • Cognitive impairment screening: every 2-3 years if normal or 1 year after borderline result.
    • Annual comprehensive eye exams.
    • Annual chronic kidney disease screening (if no dialysis) with estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio.
    • Annual lipid profile.
    • Frequent fingerstick glucose monitoring and/or continuous glucose monitoring if receiving insulin.  
  • Metformin recommended for first-line medication alongside lifestyle management.
    • Avoid metformin if gastrointestinal intolerance or impaired kidney function (eGFR 2);
    • Add insulin and/or other agents if glycemic targets unmet with metformin and lifestyle changes. 
  • Target BP of 140/90 mmHg in patients aged 65-85 with diabetes and hypertension; adjust target for comorbidities or high disease complexity.  
  • Glycemic targets of 100-140 mg/dL (5.55-7.77 mmol/L) fasting and 140-180 mg/dL (7.77-10 mmol/L) postprandial recommended for adults with diabetes in hospitals or nursing homes.