Diabetes in the Elderly

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

Graydon S. Meneilly MD, FRCPC, FACP Aileen Knip RN, MN, CDE Daniel Tessier MD, MSc, FRCPC

  • Key Messages
  • Recommendations
  • Figures
  • Full Text
  • References

Key Messages

  • Diabetes in the elderly is metabolically distinct from diabetes in younger people and the approach to therapy should be different.
  • Sulphonylureas should be used with caution because the risk of hypoglycemia increases exponentially with age.
  • Long-acting basal analogues are associated with a lower frequency of hypoglycemia than conventional insulins in this age group.
  • In elderly people, if mixture of insulin is required, the use of premixed insulins as an alternative to mixing insulins minimizes dose errors.


The definition of “elderly” varies, with some studies defining the elderly population as ≥60 years of age. Administrative guidelines frequently classify people >65 years of age as elderly. Although there is no uniformly agreed-upon definition of elderly, it is generally accepted that this is a concept that reflects an age continuum starting sometime after age 65 and is characterized by a slow, progressive impairment in function that continues until the end of life (1).


As noted in the Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome chapter (p. S8), glycated hemoglobin (A1C) can be used as 1 of the diagnostic tests for type 2 diabetes in adults. Unfortunately, normal aging is associated with a progressive increase in A1C, and there is a significant discordance between fasting plasma glucose–based and A1C-based diagnosis of diabetes in this age group, a difference that is accentuated by race and gender (2). Pending further studies to define the role of A1C in the diagnosis of diabetes in the elderly, other screening tests may need to be considered in some patients. Screening for diabetes may be warranted in select individuals. In the absence of positive intervention studies on morbidity or mortality in this population, the decision about screening for diabetes should be made on an individual basis.

Reducing the Risk of Developing Diabetes

Lifestyle interventions are effective in reducing the risk of developing diabetes in elderly people at high risk for the development of the disease (3). Acarbose (4), rosiglitazone (5) and pioglitazone (6) also are effective in preventing diabetes in elderly people at high risk. Metformin may not be effective (3).


Glycemic control

As interdisciplinary interventions, especially those that have been specifically designed for this age group, have been shown to improve glycemic control in elderly individuals with diabetes, these people should be referred to a diabetes healthcare team (7–9). Pay-for-performance programs improve a number of quality indicators in this age group (10,11). Telemedicine case management and web-based interventions can improve glycemic control, lipids, blood pressure (BP), psychosocial well-being and physical activity; reduce hypoglycemia and ethnic disparities in care; and allow for detection and remediation of medically urgent situations, as well as reduce hospitalizations (12–21). A pharmaceutical care program can significantly improve medication compliance, as well as the control of diabetes and its associated risk factors (22).

The same glycemic targets apply to otherwise healthy elderly as to younger people with diabetes. In older patients with diabetes of several years' duration and established complications, intensive control reduces the risk of microvascular events but does not reduce macrovascular events or mortality (23–25). However, better glycemic control appears to be associated with less disability and better function (26,27). It is known that postprandial glucose values are a better predictor of outcome in elderly patients with diabetes than A1C or preprandial glucose values. Recently, it has been demonstrated that older patients with type 2 diabetes who have survived an acute myocardial infarction may have a lower risk for a subsequent cardiovascular (CV) event with targeting of postprandial vs. fasting/preprandial glycemia (28). In patients with equivalent glycemic control, greater variability of glucose values is associated with worse cognition (29).

Unfortunately, aging is a risk factor for severe hypoglycemia with efforts to intensify therapy (30). Asymptomatic hypoglycemia, as assessed by continuous glucose monitoring, is frequent in this population (31). This increased risk of hypoglycemia appears to be due to an age-related reduction in glucagon secretion, impaired awareness of hypoglycemic warning symptoms and altered psychomotor performance, which prevents the patient from taking steps to treat hypoglycemia (32,33). Episodes of severe hypoglycemia may increase the risk of dementia (34), although this is controversial. Cognitive dysfunction in elderly subjects has been identified as a significant risk factor for the development of severe hypoglycemia (35,36). Therefore, the most important issue to address when attempting to achieve treatment guidelines in elderly patients is to prevent hypoglycemia as much as possible, even if that means that higher glycemic targets must be used.

“Frailty” is a widely used term associated with aging that denotes a multidimensional syndrome that gives rise to increased vulnerability. Frailty may have a biological basis and appears to be a distinct clinical syndrome. Many definitions of frailty have been proposed. The most commonly applied definition (Fried's Frailty Phenotype) suggests that a patient is frail when 3 or more of the following criteria are present: unintentional weight loss (>10 pounds in the past year), self-reported exhaustion, weakness (grip strength), slow walking speed and low physical activity (37). Progressive frailty has been associated with reduced function and increased mortality, and older patients with diabetes are more likely to be frail (38). When frailty occurs, it is a better predictor of complications and death in elderly patients with diabetes than is chronological age or burden of comorbidity (39). The Clinical Frailty Scale, developed by Rockwood et al (40), has demonstrated validity as a 7-point frailty scale that has since been modified to a 9-point frailty scale from 1 (very fit) to 9 (terminally ill), which can help to determine which subjects are frail (41) ( Figure 1 ). In people with multiple comorbidities, a high level of functional dependency and limited life expectancy (i.e. frail patients), decision analysis suggests that the benefit of intensive control is likely to be minimal (42). From a clinical perspective, the decision to offer more or less stringent glycemic control should be based on the degree of frailty. Patients with moderate or more advanced frailty ( Figure 1 ) have a reduced life expectancy and should not undergo stringent glycemic control. When attempts are made to improve glycemic control in these patients, there are fewer episodes of significant hyperglycemia but also more episodes of severe hypoglycemia (43).

Nutrition and physical activity

Nutrition education programs can improve metabolic control in ambulatory older people with diabetes (44). Amino acid supplementation may improve glycemic control and insulin sensitivity in these patients, although this is controversial (45,46). Physical training programs can be successfully implemented in older people with diabetes, although comorbid conditions may prevent aerobic physical training in many patients, and increased activity levels may be difficult to sustain. Prior to instituting an exercise program, elderly subjects should be carefully evaluated for underlying CV or musculoskeletal problems that may preclude such programs. Aerobic exercise improves arterial stiffness and baroreflex sensitivity, both surrogate markers of increased CV morbidity and mortality (47,48). While the effects of aerobic exercise programs on glucose and lipid metabolism are inconsistent (49–51), resistance training has been shown to result in modest improvements in glycemic control, as well as improvements in strength, body composition, and mobility (52–56). Exercise programs may reduce the risk of falls and improve balance in patients with neuropathy (57,58). However, it appears difficult to maintain these lifestyle changes outside of a supervised setting (59).

Oral antihyperglycemic agents

In lean elderly people with type 2 diabetes, the principal metabolic defect is impairment in glucose-induced insulin secretion (60). Therefore, initial therapy for these individuals should involve agents that stimulate insulin secretion. In obese elderly people with type 2 diabetes, the principal metabolic defect is resistance to insulin-mediated glucose disposal, with insulin secretion being relatively preserved (61–63). Initial therapy for obese older people with diabetes should involve agents that improve insulin resistance. There have been no randomized trials of metformin in the elderly, although clinical experience suggests it is an effective agent. Metformin may reduce the risk of cancer in elderly patients with diabetes (64,65). Alpha-glucosidase inhibitors are modestly effective in older people with diabetes, but a substantial percentage of individuals cannot tolerate them because of gastrointestinal side effects (66–69). Thiazolidinediones are effective agents but are associated with an increased incidence of edema and congestive heart failure (CHF) in older people (70–73). Rosiglitazone, but not pioglitazone, may increase the risk of CV events and death (74–77). These agents also increase the risk of fractures in women (77,78). When used as monotherapy, they are less likely to fail than metformin or glyburide (73). Interestingly, drugs that increase insulin sensitivity, such as thiazolidinediones and metformin, may attenuate the progressive loss in muscle mass that occurs in older people with diabetes and contributes to frailty (79).

Sulphonylureas should be used with caution because the risk of severe or fatal hypoglycemia increases exponentially with age (80,81) and appears to be higher with glyburide (82–84). Gliclazide and glimepiride are preferred over glyburide in the elderly because they are associated with a lower frequency of hypoglycemia and CV events (85–90). A long-acting formulation of gliclazide resulted in equivalent glycemic control and the same frequency of hypoglycemic events as regular gliclazide in the elderly (87), and appears to result in a lower frequency of hypoglycemic events than glimepiride (88). Meglitinides (repaglinide and nateglinide) are associated with a lower frequency of hypoglycemia in the elderly compared to glyburide (91–93) and would be preferred in individuals with irregular eating habits.

Dipeptidyl peptidase (DPP)-4 inhibitors (linagliptin, saxagliptin and sitagliptin) are similarly effective in young and old patients, cause minimal hypoglycemia when used alone and do not result in weight gain (94–97). The efficacy of liraglutide with respect to A1C and weight is independent of age and is well tolerated in the elderly with a low risk of hypoglycemia (98).

Insulin therapy

Insulin regimens in the elderly should be individualized and selected to promote patient safety. The clock drawing test can be used to predict which elderly subjects are likely to have problems with insulin therapy (99). In elderly people, the use of premixed insulins as an alternative to mixing insulins (100) and prefilled insulin pens as an alternative to conventional syringes (101,102) minimizes dose errors and may improve glycemic control. Premixed insulin analogues can be administered after meals (103–105) and may be associated with better control than basal insulins, but at the expense of more hypoglycemia and greater weight gain (106). Basal-bolus regimens may be associated with greater improvements in glycemic control, health status and mood than twice-daily injections of long-acting insulin (107), although premixed insulin analogues can result in equivalent glycemic control to basal-bolus regimens (108). In older people with poorly controlled type 2 diabetes requiring insulin, both continuous subcutaneous insulin infusion and basal-bolus regimens can result in excellent glycemic control with reduced glycemic variability, as well as good safety and patient satisfaction (109,110). One study demonstrated equivalent glycemic control in older people treated with either twice-daily insulin injections or a combination of a single injection of NPH insulin with an oral antihyperglycemic agent (111). The addition of glargine to oral agents results in improved control and a reduced frequency of hypoglycemia when compared to escalation of oral agents (112). Both detemir and glargine resulted in a reduced rate of hypoglycemia when compared to 30/70 insulin or NPH (113,114). Finally, elderly patients with diabetes are at increased risk for falls and fractures, and insulin therapy increases this risk, although the mechanism for this effect is unclear (115).

Prevention and Treatment of Complications


Treatment of isolated systolic hypertension or combined systolic and diastolic hypertension in elderly people with diabetes is associated with a significant reduction in CV morbidity and mortality and microvascular events. Also, the number needed to treat (NNT) reduces with increasing age (116–120). Treatment of isolated systolic hypertension may also preserve renal function in elderly people with diabetes (121). Several different classes of antihypertensive agents have been shown to be effective in reducing the risk of CV events and end stage renal disease, including thiazide-like diuretics, long-acting calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (116–126). Any of these agents is a reasonable first choice (122–124). Although the calcium channel blocker amlodipine may be associated with an increased risk of CHF (124), the combination of ACE inhibitor and amlodipine appears to reduce CV events more than the combination of an ACE inhibitor and hydrochlorothiazide (127). Cardioselective beta blockers and alpha-adrenergic blockers are less likely to reduce CV risk than the above agents (122–125). ACE inhibitors may be particularly valuable for people with diabetes and ≥1 other CV risk factor (128). More intensive control of BP (systolic<140 vs. <120) does not improve outcomes and results in more side effects (129). As a result, there has been discussion about altering the systolic BP target for the elderly to 140 mm Hg; however, the Canadian Hypertension Education Panel (CHEP), in collaboration with the Canadian Diabetes Association, have maintained the target BP of <130/80 mm Hg in diabetes. There has been a significant improvement in the last decade in the number of older people treated for hypertension, and therapies being used are more consistent with current clinical practice guidelines (130).


The treatment of dyslipidemia with statins for both primary and secondary prevention of CV events has been shown in most, although not all, studies to significantly reduce CV morbidity and mortality in older people with diabetes (131–139). The data on the use of fibrates in this patient population are equivocal (140,141), although they may reduce albuminuria and slow glomerular filtration rate loss (142).

Erectile dysfunction

Type 5 phosphodiesterase inhibitors appear to be effective for the treatment of erectile dysfunction in carefully selected elderly people with diabetes (143–145).


Depression is common in elderly patients with diabetes, and a systematic approach to the treatment of this illness not only improves quality of life but reduces mortality (146).

Figure 1
Clinical frailty scale.

Adapted with permission from Moorhouse P, Rockwood K. Frailty and its quantitative clinical evaluation. J R Coll Physicians Edinb. 2012;42:333-340.

Diabetes in Nursing Homes

Diabetes is often undiagnosed in nursing home patients (147–150). The prevalence of diabetes is high in institutions, and individuals frequently have established macro- and microvascular complications, as well as substantial comorbidity (150–153). Antipsychotic drug use is a risk factor for the development of diabetes in patients in institutions (154). In observational studies, the degree of glycemic control varies widely between different centres (147,152), adherence to clinical practice guidelines is poor and insulin sliding scales are used frequently despite lack of evidence for their effectiveness (150). Undernutrition is a major problem in people with diabetes living in nursing homes (152).

There are very few intervention studies on diabetes in nursing homes. The short-term substitution of a regular diet or a standard nutritional formula for a “diabetic diet” or a diabetic nutritional formula did not modify the level of glycemic control (150,155–157). For selected nursing home residents with type 2 diabetes, substitution of regular insulin by lispro insulin (bolus analogue) may improve glycemic control and A1C levels with a reduced number of hypoglycemic episodes (158).


  1. 1.Healthy elderly people with diabetes should be treated to achieve the same glycemic, blood pressure and lipid targets as younger people with diabetes [Grade D, Consensus].
  2. 2.In the frail elderly, while avoiding symptomatic hyperglycemia, glycemic targets should be A1C ≤8.5% and fasting plasma glucose or preprandial PG 5.0–12.0 mmol/L, depending on the level of frailty. Prevention of hypoglycemia should take priority over attainment of glycemic targets because the risks of hypoglycemia are magnified in this patient population [Grade D, Consensus].
  3. 3.In elderly people with cognitive impairment, strategies should be used to strictly prevent hypoglycemia, which include the choice of antihyperglycemic therapy and less stringent A1C target [Grade D, Consensus].
  4. 4.Elderly people with type 2 diabetes should perform aerobic exercise and/or resistance training, if not contraindicated, to improve glycemic control [Grade B, Level 2 (49–53)].
  5. 5.In elderly people with type 2 diabetes, sulphonylureas should be used with caution because the risk of hypoglycemia increases exponentially with age [Grade D, Level 4 (80) ].
    • In general, initial doses of sulphonylureas in the elderly should be half of those used for younger people, and doses should be increased more slowly [Grade D, Consensus].
    • Gliclazide and gliclazide MR [Grade B, Level 2 (85,87) ] and glimepiride [Grade C, Level 3 (86) ] should be used instead of glyburide, as they are associated with a reduced frequency of hypoglycemic events.
    • Meglitinides may be used instead of glyburide to reduce the risk of hypoglycemia [Grade C Level 2 (92) for repaglinide; Grade C, Level 3 (93) for nateglinide], particularly in patients with irregular eating habits [Grade D Consensus].
  6. 6.In elderly people, thiazolidinediones should be used with caution due to the increased risk of fractures and heart failure [Grade D Consensus].
  7. 7.Detemir and glargine may be used instead of NPH or human 30/70 insulin to lower the frequency of hypoglycemic events [Grade B, Level 2 (113,114)].
  8. 8.In elderly people, if insulin mixture is required, premixed insulins and prefilled insulin pens should be used instead of mixing insulins to reduce dosing errors and to potentially improve glycemic control [Grade B, Level 2 (100–102) ].
  9. 9.The clock drawing test may be used to predict which elderly subjects will have difficulty learning to inject insulin [Grade D, Level 4 (99)].
  10. 10.In elderly nursing home residents, regular diets may be used instead of “diabetic diets” or nutritional formulas [Grade D, Level 4 (155–157)].


  1. 1 D. Tessier G.S. Meneilly Diabetes management in the elderly H.C. Gerstein R.B. Haynes Evidence-based Diabetes Care 2001 BC Decker Inc Hamilton, ON 370 379
  2. 2 K.J. Lipska N. De Rekeneire P.H. Van Ness Identifying dysglycemic states in older adults: implications of the emerging use of hemoglobin A1C J Clin Endrocinol Metab 95 2010 5289 5295
  3. 3 Diabetes Prevention Program Research Group J. Crandall D. Schade Y. Ma The influence of age on the effects of lifestyle modification and metformin in prevention of diabetes J Gerontol A Biol Med Sci 61 2006 1075 1081
  4. 4 J.L. Chiasson R.G. Josse R. Gomis STOP-NIDDM Trial Research Group Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial Lancet 359 2002 2072 2077
  5. 5 DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators H.C. Gerstein S. Yusuf J. Bosch Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomized controlled trial Lancet 368 2006 1096 1105
  6. 6 R.A. DeFronzo D. Tripathy D.C. Schwenke Pioglitazone for diabetes prevention in impaired glucose tolerance N Engl J Med 364 2011 1104 1115
  7. 7 P. Kronsbein V. Jörgens I. Mühlhauser Evaluation of a structured treatment and teaching programme on non-insulin-dependent diabetes Lancet 2 1988 1407 1411
  8. 8 W. Wilson C. Pratt The impact of diabetes education and peer support upon weight and glycemic control of elderly persons with noninsulin dependent diabetes mellitus (NIDDM) Am J Public Health 77 1987 634 635
  9. 9 A.K. Braun T. Kubiak J. Kuntsche SGS: a structured treatment and teaching programme for older patients with diabetes mellitus: a prospective randomized controlled multi-centre trial Age Ageing 38 2009 390 396
  10. 10 P.J. Fagan A.B. Schuster C. Boyd Chronic care improvement in primary care: evaluation of an integrated pay-for-performance and practice-based care coordination program among elderly patients with diabetes Health Serv Res 45 2010 1763 1782
  11. 11 M.P. McGovern D.J. Williams P.C. Hannaford Introduction of a new incentive and target-based contract for family physicians in the UK: good for older patients with diabetes but less good for women? Diabet Med 25 2008 1083 1089
  12. 12 S. Shea R.S. Weinstock J.A. Teresi A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel Study J Am Med Inform Assoc 16 2009 446 456
  13. 13 R.S. Weinstock J.A. Teresi R. Goland Glycemic control and health disparities in older ethnically diverse underserved adults with diabetes Diabetes Care 34 2011 274 279
  14. 14 P.M. Trief J.A. Teresi J.P. Eimcke Improvement in diabetes self-efficacy and glycaemic control using telemedicine in a sample of older, ethnically diverse individuals who have diabetes: the IDEATel project Age Ageing 38 2009 219 225
  15. 15 R.S. Weinstock G. Brooks W. Palmas Lessened decline in physical activity and impairment of older adults with diabetes with telemedicine and pedometer use: results from the IDEATel study Age Ageing 40 2011 98 105
  16. 16 R. Izquierdo S. Meyer J. Starren Detection and remediation of medically urgent situations using telemedicine case management for older patients with diabetes mellitus Ther Clin Risk Manag 3 2007 485 489
  17. 17 S. Lim S.M. Kang H. Shin Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous health care service, a new medical information system Diabetes Care 34 2011 308 313
  18. 18 G.E. Bond R.L. Burr F.M. Wolf The effects of a web-based intervention on psychosocial well being among adults aged 60 and older with diabetes: a randomized trial Diabetes Educ 36 2010 446
  19. 19 G.E. Bond R. Burr F.M. Wolf The effects of a web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: a randomized trial Diabetes Technol Ther 9 2007 52 59
  20. 20 G.D. Berg S. Wadhwa Health services outcomes for a diabetes disease management program for the elderly Dis Manag 10 2007 226 235
  21. 21 J.L. Rosenweig M.S. Taitel G.K. Norman Diabetes disease management in Medicare advantage reduces hospitalizations and costs Am J Manag Care 16 2010 e157 e162
  22. 22 P.R. Obreli-Neto C.M. Guidoni A.O. Baldoni Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients Int J Clin Pharm 33 2011 642 649
  23. 23 F.M. Turnbull C. Abraira R.J. Anderson Intensive glucose control and macrovascular outcomes in type 2 diabetes Diabetologia 52 2009 2288 2298
  24. 24 The ADVANCE collaborative group Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes N Engl J Med 358 2008 2560 2572
  25. 25 The ACCORD study group Effects of intensive glucose lowering in type 2 diabetes N Engl J Med 358 2008 2545 2559
  26. 26 C.-P. Wang H.P. Hazuda Better glycemic control is associated with maintenance of lower-extremity function over time in Mexican American and European American older adults with diabetes Diabetes Care 34 2011 268 273
  27. 27 R.R. Kalyani C.D. Sauder F.L. Brancati E. Selvin Association of diabetes, comorbidities and A1c with functional disability in older adults Diabetes Care 33 2010 1055 1060
  28. 28 I. Raz A. Ceriello P.W. Wilson Post hoc subgroup analysis of the HEART2D Trial demonstrates lower cardiovascular risk in older patients targeting postprandial versus fasting/premeal glycemia Diabetes Care 34 2011 1511 1513
  29. 29 M.R. Rizzo R. Marfella M. Barbieri Relationships between daily acute glucose fluctuations and cognitive performance among aged type 2 diabetic patients Diabetes Care 33 2010 2169 2174
  30. 30 M.E. Miller D.E. Bonds H. Gerstein The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study BMJ 340 2010 b5444
  31. 31 M.N. Munshi A.R. Segal E. Emmy Suhl Frequent hypoglycemia among elderly patients with poor glycemic control Arch Intern Med 171 2011 362 364
  32. 32 G.S. Meneilly E. Cheung H. Tuokko Counterregulatory hormone responses to hypoglycemia in the elderly patient with diabetes Diabetes 43 1994 403 410
  33. 33 J.P. Bremer K. Jauch-Chara M. Hallschmid Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes Diabetes Care 32 2009 1513 1517
  34. 34 R.A. Whitmer A.J. Karter K. Yaffe Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus JAMA 301 2009 1565 1572
  35. 35 B.E. De Galan S. Zoungas J. Chalmers Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with type 2 diabetes: the action in diabetes and vascular disease: preterax and diamicron modified release controlled evaluation (ADVANCE) trial Diabetologia 52 2009 2328 2336
  36. 36 D.G. Bruce W.A. Davis G.P. Casey Severe hypoglycemia and cognitive impairment in older patients with diabetes: the Freemantle Diabetes Study Diabetologia 52 2009 1808 1815
  37. 37 L.P. Fried C.M. Tangen J. Walston Frailty in older adults: evidence for a phenotype J Gerontol Med Sci 56A 2001 M146 M156
  38. 38 C.S. Blaum Q.L. Xue J. Tian Is hyperglycemia associated with frailty status in older women? J Am Geriatr Soc 57 2009 840 847
  39. 39 R.E. Hubbard M.K. Andrew H. Fallah K. Rockwood Comparison of the prognostic importance of diagnosed diabetes, co-morbidity and frailty in older people Diabet Med 27 2010 603 606
  40. 40 K. Rockwood X. Song C. MacKnight A global clinical measure of fitness and frailty in elderly people CMAJ 173 2005 489 495
  41. 41 P. Moorhouse K. Rockwood Frailty and its quantitative clinical evaluation J R Coll Physicians Edinb 42 2012 333 340
  42. 42 E.S. Huang Q. Zhang N. Gandra The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis Ann Intern Med 149 2008 11 19
  43. 43 S.J. Lee W.J. Boscardin I.S. Cenzer The risks and benefits of implementing glycemic control guidelines in frail older adults with diabetes mellitus J Am Geriatr Soc 59 2011 666 672
  44. 44 C.K. Miller L. Edwards G. Kissling Nutrition education improves metabolic outcomes among older adults with diabetes mellitus: results from a randomized controlled trial Prev Med 34 2002 252 259
  45. 45 S.B. Solerte M. Fioravanti E. Locatelli Improvement of blood glucose control and insulin sensitivity during a long-term (60 weeks) randomized study with amino acid dietary supplements in elderly subjects with type 2 diabetes mellitus Am J Cardiol 101 suppl 2008 82E 88E
  46. 46 M. Leenders L.B. Verdijk L. van der Hoeven Prolonged leucine supplementation does not augment muscle mass or affect glycemic control in elderly type 2 diabetic men J Nutr 141 2011 1070 1076
  47. 47 K.M. Madden C. Lockhart D. Cuff Short-term aerobic exercise reduces arterial stiffness in older adults with type 2 diabetes, hypertension and hypercholesterolemia Diabetes Care 32 2009 1531 1535
  48. 48 K.M. Madden C. Lockhart T.F. Potter D. Cuff Aerobic training restores arterial baroreflex sensitivity in older adults with 2 type diabetes, hypertension and hypercholesterolemia Clin J Sport Med 20 2010 312 317
  49. 49 D. Tessier J. Ménard T. Fülöp Effects of aerobic physical exercise in the elderly with type 2 diabetes mellitus Arch Gerontol Geriatr 31 2000 121 132
  50. 50 P.C. Ligtenberg G.L.R. Godaert E.F. Hillenaar Influence of a physical training program on psychological well being in elderly type 2 diabetes patients. Psychological well being, physical training, and type 2 diabetes [letter] Diabetes Care 21 1998 2196 2197
  51. 51 P.C. Ligtenberg J.B.L. Hoekstra E. Bol Effects of physical training on metabolic control in elderly type 2 diabetes mellitus patients Clin Sci (Lond) 93 1997 127 135
  52. 52 D.W. Dunstan R.M. Daly N. Owen High-intensity resistance training improves glycemic control in older patients with type 2 diabetes Diabetes Care 25 2002 1729 1736
  53. 53 C. Castaneda J.E. Layne L. Munoz-Orians A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes Diabetes Care 25 2002 2335 2341
  54. 54 L.J. Brandon D.A. Gaasch L.W. Boyette Effects of long-term resistive training on mobility and strength in older adults with diabetes J Gerontol A Biol Sci Med Sci 58 2003 740 745
  55. 55 D.J. Cuff G.S. Meneilly A. Martin Effective exercise modality to reduce insulin resistance in women with type 2 diabetes Diabetes Care 26 2003 2977 2982
  56. 56 J. Ibanez M. Izquierdo I. Argüelles Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes Diabetes Care 28 2005 662 667
  57. 57 S. Morrison S.R. Colberg M. Mariano Balance training reduces falls risk in older individuals with type 2 diabetes Diabetes Care 33 2010 748 750
  58. 58 C.H. Song J.S. Petrofsky S.W. Lee Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies Diabet Technol Ther 13 2011 803 811
  59. 59 D.W. Dunstan R.M. Daly N. Owen Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes Diabetes Care 28 2005 3 9
  60. 60 G.S. Meneilly D. Elahi Metabolic alterations in middle-aged and elderly lean patients with type 2 diabetes Diabetes Care 28 2005 1498 1499
  61. 61 G.S. Meneilly T. Elliott Metabolic alterations in middle-aged and elderly obese patients with type 2 diabetes Diabetes Care 22 1999 112 118
  62. 62 G.S. Meneilly T. Elliott D. Tessier NIDDM in the elderly Diabetes Care 19 1996 1320 1325
  63. 63 P. Arner T. Pollare H. Lithell Different aetiologies of type 2 (non-insulin-dependent) diabetes mellitus in obese and non-obese subjects Diabetologia 34 1991 483 487
  64. 64 G. Libby L.A. Donnelly P.T. Donnan New users of metformin are at low risk of incident cancer Diabetes Care 32 2009 1620 1625
  65. 65 D.M. Baur J. Klotsche R. Ole-Petter O.P.R. Hamnvik Type 2 diabetes mellitus and medications for type 2 diabetes mellitus are associated with risk for and mortality from cancer in a German primary care cohort Metabolism 60 2011 1363 1371
  66. 66 P.S. Johnston H.E. Lebovitz R.F. Coniff Advantages of alpha-glucosidase inhibition as monotherapy in elderly type 2 diabetic patients J Clin Endocrinol Metab 83 1998 1515 1522
  67. 67 H. Orimo I. Akiguchi M. Shiraki Usefulness of acarbose in the management of non-insulin-dependent diabetes in the aged W. Creutzfeldt Acarbose 1982 Excerpta Medica New York 348 352
  68. 68 K. Johansen Acarbose treatment of sulfonylurea-treated non-insulin dependent diabetics: a double-blind cross-over comparison of an alpha-glucosidase inhibitor with metformin Diabet Metab 10 1984 219 223
  69. 69 R.G. Josse J.L. Chiasson E.A. Ryan Acarbose in the treatment of elderly patients with type 2 diabetes Diabetes Res Clin Pract 59 2003 37 42
  70. 70 J. Chilcott P. Tappenden M.L. Jones A systematic review of the clinical effectiveness of pioglitazone in the treatment of type 2 diabetes mellitus Clin Ther 23 2001 1792 1823
  71. 71 R. Rajagopalan A. Perez Z. Ye Pioglitazone is effective therapy for elderly patients with type 2 diabetes mellitus Drugs Aging 21 2004 259 271
  72. 72 M. Kreider M. Heise Rosiglitazone in the management of older patients with type 2 diabetes mellitus Int J Clin Pract 56 2002 538 541
  73. 73 S.E. Kahn S.M. Haffner M.A. Heise ADOPT Study Group Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy N Engl J Med 355 2006 2427 2443
  74. 74 W.C. Winkelmayer S. Setoguchi R. Levin D.H. Soloman Comparison of cardiovascular outcomes in elderly patients with diabetes who initiated rosiglitazone vs pioglitazone therapy Arch Intern Med 168 2008 2368 2375
  75. 75 D.J. Graham R. Ouellet-Hellstrom T.E. MaCurdy Risk of acute myocardial infarction, stroke, heart failure and death in elderly Medicare patients treated with rosiglitazone or pioglitazone JAMA 304 2010 411 418
  76. 76 L.L. Lipscombe T. Gomes L.E. Lévesque Thiazolidinediones and cardiovascular outcomes in older patients with diabetes JAMA 298 2007 2634 2643
  77. 77 P.D. Home S.J. Pocock H. Beck-Nielsen RECORD Study Team Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomized, open-label trial Lancet 373 2009 2125 2135
  78. 78 Y.K. Loke S. Singh C.D. Furberg Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis CMAJ 180 2009 32 39
  79. 79 C.G. Lee E.J. Boyko E. Barrett-Connor Insulin sensitizers may attenuate lean mass loss in older men with diabetes Diabetes Care 34 2011 2381 2386
  80. 80 K. Asplund B.E. Wiholm F. Lithner Glibenclamide-associated hypoglycaemia: a report on 57 cases Diabetologia 24 1983 412 417
  81. 81 R.I. Shorr W.A. Ray J.R. Daugherty Individual sulfonylureas and serious hypoglycemia in older people J Am Geriatr Soc 44 1996 751 755
  82. 82 R.I. Shorr W.A. Ray J.R. Daugherty Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas Arch Intern Med 157 1997 1681 1686
  83. 83 S.P. Johnsen T.B. Monster M.L. Olsen Risk and short term prognosis of myocardial infarction among users of antidiabetic drugs Am J Ther 13 2006 134 140
  84. 84 D. Greco M. Pisciotta F. Gambina F. Maggio Severe hypoglycaemia leading to hospital admission in type 2 diabetic patients aged 80 years or older Exp Clin Endocrinol Diabetes 118 2010 215 219
  85. 85 D. Tessier K. Dawson J.P. Tétrault Glibenclamide vs gliclazide in type 2 diabetes of the elderly Diabet Med 11 1994 974 980
  86. 86 A. Holstein A. Plaschke E.H. Egberts Lower incidence of severe hypoglycaemia in patients with type 2 diabetes treated with glimepiride versus glibenclamide Diabetes Metab Res Rev 17 2001 467 473
  87. 87 Diamicron MR Study Group Diamicron MR once daily is effective and well tolerated in type 2 diabetes: a double-blind, randomized, multinational study J Diabetes Complications 14 2000 185 191
  88. 88 G. Schernthaner A. Grimaldi U. Di Mario GUIDE study: double-blind comparison of once-daily gliclazide MR and glimepiride in type 2 diabetic patients Eur J Clin Invest 34 2004 535 542
  89. 89 M. Zeller N. Danchin D. Simon French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction Investigators Impact of type of preadmission sulfonylureas on mortality and cardiovascular outcomes in diabetic patients with acute myocardial infarction J Clin Endocrinol Metab 95 2010 4993 5002
  90. 90 K.M. Pantalone M.W. Kattan C. Yu The risk of overall mortality in patients with type 2 diabetes receiving glipizide, glyburide, or glimepiride monotherapy Diabetes Care 33 2010 1224 1229
  91. 91 S. Del Prato R.J. Heine L. Keilson Treatment of patients over 64 years of age with type 2 diabetes: experience from nateglinide pooled database retrospective analysis Diabetes Care 26 2003 2075 2080
  92. 92 G. Papa V. Fedele M.R. Rizzo Safety of type 2 diabetes treatment with repaglinide compared with glibenclamide in elderly people: a randomized, open-label, two-period, cross-over trial Diabetes Care 29 2006 1918 1920
  93. 93 S.L. Schwartz J.E. Gerich A. Marcellari Nateglinide, alone or in combination with metformin, is effective and well tolerated in treatment-naïve elderly patients with type 2 diabetes Diabetes Obes Metab 10 2008 652 660
  94. 94 S.L. Schwartz Treatment of elderly patients with type 2 diabetes mellitus: a systematic review of the benefits and risks of dipeptidyl peptidase-4 inhibitors Am J Geriatr Pharmacother 8 2010 405 418
  95. 95 J. Doucet A. Chacra P. Maheux Efficacy and safety of saxagliptin in older patients with type 2 diabetes mellitus Curr Med Res Opin 27 2011 863 869
  96. 96 N. Barzilai H. Guo E.M. Mahoney Efficacy and tolerability of sitagliptin monotherapy in elderly patients with type 2 diabetes: a randomized, double-blind, placebo-controlled trial Curr Med Res Opin 27 2011 1049 1058
  97. 97 M.N. Chien C.C. Lee W.C. Chen Effect of sitagliptin as add-on therapy in elderly type 2 diabetes patients with inadequate glycemic control in Taiwan Int J Gerontol 5 2011 103 106
  98. 98 B.W. Bode J. Brett A. Falahati R.E. Pratley Comparison of the efficacy and tolerability profile of liraglutide, a once daily human GLP-1 analog in patients with type 2 diabetes ≥65 and <65 years of age: a pooled analysis from phase III studies Am J Geriatr Pharmacother 9 2011 423 433
  99. 99 L.A. Trimble S. Sundberg L. Markham Value of the clock drawing test to predict problems with insulin skills in older adults Can J Diabetes 29 2005 102 104
  100. 100 C. Coscelli G. Calabrese D. Fedele Use of premixed insulin among the elderly: reduction of errors in patient preparation of mixtures Diabetes Care 15 1992 1628 1630
  101. 101 A. Corsi E. Torre G.A. Coronel Pre-filled insulin pen in newly insulin-treated diabetic patients over 60 years old Diabetes Nutr Metab 10 1997 78 81
  102. 102 C. Coscelli S. Lostia M. Lunetta Safety, efficacy, acceptability of a pre-filled insulin pen in diabetic patients over 60 years old Diabetes Res Clin Pract 28 1995 173 177
  103. 103 M. Herz B. Sun Z. Milicevic Comparative efficacy of preprandial or postprandial Humalog Mix75/25 versus glyburide in patients 60 to 80 years of age with type 2 diabetes mellitus Clin Ther 24 2002 73 86
  104. 104 M.L. Warren M.J. Conway L.J. Klaff Postprandial versus preprandial dosing of biphasic insulin aspart in elderly type 2 diabetes patients Diabetes Res Clin Pract 66 2004 23 29
  105. 105 E. Galic M. Vrtovec V. Bozikov The impact of the timing of Humalog Mix25 injections on blood glucose fluctuations in the postprandial period in elderly patients with type 2 diabetes Med Sci Monit 11 2005 P187 P192
  106. 106 B.H.R. Wolffenbuttel L.J. Klaff R. Bhushant Initiating insulin therapy in elderly patients with type 2 diabetes: efficacy and safety of lispro mix 25 vs. basal insulin combined with oral glucose lowering agents Diabet Med 26 2009 1147 1155
  107. 107 T.J. Hendra C.D. Taylor A randomized trial of insulin on well being and carrier strain in elderly type 2 diabetic subjects J Diabetes Complications 18 2004 148 154
  108. 108 K. Aria K. Hirao M. Yamauchi Japanese Diabetes Clinical Data Management Study Group Influence of BMI, age and duration of diabetes mellitus on glycaemic control with twice-daily injections of biphasic insulin aspart 30 versus multiple daily injections of insulin aspart (JDDM 18): retrospective reanalysis of a 6-month, randomized, open-label, multicentre trial in Japan Clin Drug Invest 30 2010 35 40
  109. 109 W.H. Herman L.L. Ilag S.L. Johnson A clinical trial of continuous subcutaneous insulin infusion versus multiple daily injections in older adults with type 2 diabetes Diabetes Care 28 2005 1568 1573
  110. 110 S.L. Johnson L.N. McEwan C.A. Newton The impact of continuous subcutaneous insulin infusion and multiple daily injections of insulin on glucose variability in older adults with type 2 diabetes J Diabetes Complications 25 2011 211 215
  111. 111 B.H. Wolffenbuttel J.P. Sels G.J. Rondas-Colbers Comparison of different insulin regimens in elderly patients with NIDDM Diabetes Care 19 1996 1326 1332
  112. 112 G. Papa V. Fedele A. Chiavetta Therapeutic options for elderly diabetic subjects: open label, randomized clinical trial of insulin glargine added to oral antidiabetic drugs versus increased dosage of oral antidiabetic drugs Acta Diabetol 45 2008 53 59
  113. 113 H.U. Janka G. Plewe K. Busch Combination of oral antidiabetic agents with basal insulin versus premixed insulin alone in randomized elderly patients with type 2 diabetes mellitus J Am Geriatr Soc 55 2007 182 188
  114. 114 A.J. Garber P. Clauson C.B. Pedersen K. Kolendorf Lower risk of hypoglycemia with insulin detemir than with neutral protamine Hagedorn insulin in older persons with type 2 diabetes: a pooled analysis of Phase III trials J Am Geriatr Soc 55 2007 1735 1740
  115. 115 H.D. Berlie C.L. Garwood Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly Ann Pharmacother 44 2010 712 717
  116. 116 J.D. Curb S.L. Pressel J.A. Cutler Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group JAMA 276 1996 1886 1892
  117. 117 J.G. Wang J.A. Staessen L. Gong Chinese trial on isolated systolic hypertension in the elderly. Systolic Hypertension in China (Syst-China) Collaborative Group Arch Intern Med 160 2000 211 220
  118. 118 J. Tuomilehto D. Rastenyte W.H. Birkenhäger Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators N Engl J Med 340 1999 677 684
  119. 119 L.H. Lindholm L. Hansson T. Ekbom Comparison of antihypertensive treatments in preventing cardiovascular events in elderly diabetic patients: results from the Swedish Trial in Old Patients with Hypertension-2. STOP Hypertension-2 Study Group J Hypertens 18 2000 1671 1675
  120. 120 N. Toshiharu S. Zoungas B. Neal Efficacy and safety of routine blood pressure lowering in older patients with diabetes: results from the ADVANCE Collaborative Group J Hypertens 28 2010 1141 1149
  121. 121 S.M. Voyaki J.A. Staessen L. Thijs Systolic Hypertension in Europe (Syst-Eur) Trial Investigators Follow-up of renal function in treated and untreated older patients with isolated systolic hypertension J Hypertens 19 2001 511 519
  122. 122 J.I. Barzilay B.R. Davis J. Bettencourt ALLHAT Collaborative Research Group Cardiovascular outcomes using doxazosin vs. chlorthalidone for the treatment of hypertension in older adults with and without glucose disorders: a report from the ALLHAT study J ClinHypertens 6 2004 116 125
  123. 123 M. Rahman S. Pressel B.R. Davis Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Arch Intern Med 165 2005 936 946
  124. 124 P.K. Whelton J. Barzilay W.C. Cushman ALLHAT Collaborative Research Group Clinical outcomes in antihypertensive treatment of type 2 diabetes, impaired fasting glucose concentration, and normoglycemia: Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALL-HAT) Arch Intern Med 165 2005 1401 1409
  125. 125 S.E. Kjeldsen B. Dahlöf R.B. Devereux LIFE (Losartan Intervention for Endpoint Reduction) Study Group Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: a Losartan Intervention for Endpoint Reduction (LIFE) substudy JAMA 288 2002 1491 1498
  126. 126 R. Ferrari Perindopril and Remodeling in Elderly with Acute Myocardial Infarction Investigators Effects of angiotensin-converting enzyme inhibition with perindopril on left ventricular remodeling and clinical outcome: results of the randomized Perindopril and Remodeling in Elderly with Acute Myocardial Infarction (PREAMI) Study Arch Intern Med 166 2006 659 666
  127. 127 M.A. Weber G.L. Bakris K. Jamerson ACCOMPLISH Investigators Cardiovascular events during differing hypertension therapies in patients with diabetes J Am Coll Cardiol 56 2010 77 85
  128. 128 Heart Outcomes Prevention Evaluation Study Investigators Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy Lancet 355 2000 253 259
  129. 129 W.C. Cushman G.W. Evans R.P. Byington Effects of intensive blood pressure control in type 2 diabetes mellitus N Engl J Med 362 2010 1575 1585
  130. 130 F.A. McAlister N.R. Campbell M. Duong-Hua Antihypertensive medication prescribing in 27,822 elderly Canadians with diabetes over the past decade Diabetes Care 29 2006 836 841
  131. 131 C. Baigent A. Keech P.M. Kearney Cholesterol Treatment Trialists' (CTT) Collaborators Efficacy and safety of cholesterol lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins Lancet 366 2005 1267 1278
  132. 132 R. Collins J. Armitage S. Parish Heart Protection Study Collaborative Group Effects of cholesterol lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high risk conditions Lancet 363 2004 757 767
  133. 133 R. Collins J. Armitage S. Parish Heart Protection Study Collaborative Group MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial Lancet 361 2003 2005 2016
  134. 134 Heart Protection Study Collaborative Group The effects of cholesterol lowering with simvastatin on cause-specific mortality and on cancer incidence in 20,536 high-risk people: a randomized placebo-controlled trial (ISRCTN48489393) BMC Med 3 2005 6
  135. 135 Heart Protection Study Collaborative Group MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial Lancet 360 2002 7 22
  136. 136 A. Keech D. Colquhoun J. Best LIPID Study Group Secondary prevention of cardiovascular events with long-term pravastatin in patients with diabetes or impaired fasting glucose: results from the LIPID trial Diabetes Care 26 2003 2713 2721
  137. 137 H.A. Neil D.A. DeMicco D. Luo CARDS Study Investigators Analysis of efficacy and safety in patients aged 65-75 years at randomization: Collaborative Atorvastatin Diabetes Study (CARDS) Diabetes Care 29 2006 2378 2384
  138. 138 ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT) JAMA 288 2002 2998 3007
  139. 139 P.S. Sever N.R. Poulter B. Dahlöf Reduction in cardiovascular events with atorvastatin in 2,532 patients with type 2 diabetes: Anglo-Scandinavian Cardiac Outcomes Trial–lipid lowering arm (ASCOT-LLA) Diabetes Care 28 2005 1151 1157
  140. 140 H.B. Rubins S.J. Robins D. Collins Diabetes, plasma insulin, and cardiovascular disease: subgroup analysis from the Department of Veterans Affairs high-density lipoprotein intervention trial (VA-HIT) Arch Intern Med 162 2002 2597 2604
  141. 141 H.N. Ginsberg M.B. Elam L.C. Lovato Effects of combination lipid therapy in type 2 diabetes mellitus N Engl J Med 362 2010 1563 1574
  142. 142 T.M.E. Davis R. Ting J.D. Best the FIELD Study Investigators Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the fenofibrate intervention and event lowering in diabetes (FIELD) study Diabetologia 54 2011 280 290
  143. 143 G. Wagner F. Montorsi S. Auerbach Sildenafil citrate (VIAGRA) improves erectile function in elderly patients with erectile dysfunction: a subgroup analysis J Gerontol A Biol Sci Med Sci 56A 2001 M113 M119
  144. 144 I. Sáenz de Tejada G. Anglin J.R. Knight Effects of tadalafil on erectile dysfunction in men with diabetes Diabetes Care 25 2002 2159 2164
  145. 145 I. Goldstein J.M. Young J. Fischer Vardenafil Diabetes Study Group Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study Diabetes Care 26 2003 777 783
  146. 146 H.R. Bogner K.H. Morales E.P. Post M.L. Bruce A randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT) Diabetes Care 30 2007 3005 3010
  147. 147 H. Hauner A.A. Kurnaz B. Haastert Undiagnosed diabetes mellitus and metabolic control assessed by HbA(1c) among residents of nursing homes Exp Clin Endocrinol Diabetes 109 2001 326 329
  148. 148 A.J. Sinclair R. Gadsby S. Penfold Prevalence of diabetes in care home residents Diabetes Care 24 2001 1066 1068
  149. 149 T.J. Aspray K. Nesbit T.P. Cassidy Diabetes in British nursing and residential homes: a pragmatic screening study Diabetes Care 29 2006 707 708
  150. 150 T.J. Garcia S.A. Brown Diabetes management in the nursing home: a systematic review of the literature Diabetes Educ 37 2011 167 187
  151. 151 B.H. Wolffenbuttel S. vanVliet A. Knols Clinical characteristics and management of diabetic patients residing in a nursing home Diabetes Res Clin Pract 13 1991 199 206
  152. 152 A.D. Mooradian D. Osterweil D. Petrasek Diabetes mellitus in elderly nursing home patients: a survey of clinical characteristics and management J Am Geriatr Soc 36 1988 391 396
  153. 153 S.B. Dybicz S. Thompson S. Molotsky B. Stuart Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents Am J Geriatr Pharmacother 9 2011 212 223
  154. 154 J.J. Jalbert L.A. Daiellon C.B. Eaton Antipsychotic use and the risk of diabetes in nursing home residents with dementia Am J Geriatr Pharmacother 9 2011 153 163
  155. 155 A.M. Coulston D. Mandelbaum G.M. Reaven Dietary management of nursing home residents with non-insulin-dependent diabetes mellitus Am J Clin Nutr 51 1990 67 71
  156. 156 S.H. Tariq E. Karcic D.R. Thomas The use of a no-concentrated-sweets diet in the management of type 2 diabetes in nursing homes J Am Diet Assoc 101 2001 1463 1466
  157. 157 Y. Levinson A. Epstein B. Adler Successful use of a sucrose-containing enteral formula in diabetic nursing home elderly Diabetes Care 29 2006 698 700
  158. 158 M. Velussi Lispro insulin treatment in comparison with regular human insulin in type 2 diabetic patients living in nursing homes Diabetes Nutri Metab 15 2002 96 100
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