Evidence‐based diabetes care for older people with Type 2 diabetes: a critical review

In our ageing society diabetes imposes a significant burden in terms of the numbers of people with the condition, diabetes‐related complications including disability, and health and social care expenditure. Older people with diabetes can represent some of the more complex and difficult challenges facing the clinician working in different settings, and the recognition that we have only a relatively small (but increasing) evidence base to guide us in diabetes management is a limitation of our current approaches. Nevertheless, in this review we attempt to explore what evidence there is to guide us in a comprehensive scheme of treatment for older adults, often in a high‐risk clinical state, in terms of glucose lowering, blood pressure and lipid management, frailty care and lifestyle interventions. We strive towards individualized care and make a call for action for more high‐quality research using different trial designs. What's new? This review represents a modern, up‐to‐date account of published evidence that seeks to examine the significance of previous research relating to the management of diabetes in older people. The review also provides a diagrammatic view of the development of the complex illness scenarios seen in ageing people with diabetes, and provides the first detailed algorithm for developing individualized care programmes in this often vulnerable group. The evidence review takes us through glucose‐lowering trials involving older people, a discussion of important cardiovascular outcome and safety trials relevant to the elderly, in addition to a discussion of insulin therapy, lifestyle interventions and managing frailty. This review concludes with a call to action to promote new research in older adults with diabetes with the hope of optimizing clinical outcomes in the future.