Diabetes is prevalent in older adults, with over 25% of those aged 65+ having the condition. Older adults with diabetes face higher mortality, reduced functional status, and increased institutionalization risks. Despite high prevalence, older adults are often excluded from clinical trials, complicating treatment strategies. The American Diabetes Association convened a conference to address diabetes in older adults, highlighting the need for individualized care. Epidemiologically, diabetes prevalence in older adults varies from 22 to 33%, with postprandial hyperglycemia being common. Type 2 diabetes is linked to aging, obesity, and increased prevalence. Older adults with diabetes have higher rates of complications like amputations, MI, and renal disease. Screening for diabetes and prediabetes is recommended for high-risk individuals, with evidence supporting early intervention. Prevention and treatment of diabetes in older adults involve lifestyle interventions and medications. The Diabetes Prevention Program showed lifestyle interventions were effective in older participants, though metformin had limited benefits. Glycemic control studies, such as UKPDS, ADVANCE, and VADT, show mixed results, with some indicating benefits and others showing no significant effect. Intensive glycemic control in older adults may increase risks, especially for those with long diabetes duration. Lipid-lowering therapies like statins are beneficial for older adults with diabetes, especially for cardiovascular prevention. Blood pressure control is also important, with targets like <140 mmHg for SBP. Aspirin is recommended for older adults with diabetes and CVD, though risks of bleeding must be considered. Screening for chronic complications is essential, with individualized approaches based on patient characteristics. Guidelines from the ADA and other organizations suggest individualized glycemic targets, considering comorbidities and life expectancy. For example, A1C targets may be less strict for those with limited life expectancy or advanced complications. Comorbidities and geriatric syndromes, such as cognitive dysfunction, functional impairment, and falls, are common in older adults with diabetes. These conditions require tailored management, including simplified regimens, caregiver involvement, and regular assessments. Nutrition is crucial, with older adults at risk for deficiencies due to reduced caloric intake. MNT is recommended, considering cultural and personal preferences. Physical activity is beneficial, with even light-intensity exercise improving health outcomes. Pharmacotherapy in older adults requires careful consideration of drug interactions, renal function, and hypoglycemia risks. Metformin is often first-line, but other medications like sulfonylureas and glinides have higher hypoglycemia risks. Insulin therapy is used when appropriate, with careful monitoring of hypoglycemia. Overall, individualized care is essential for older adults with diabetes, considering their unique health status, comorbidities, and life expectancy. This approach ensures effective management of diabetes and its complications while minimizing risks.Diabetes is prevalent in older adults, with over 25% of those aged 65+ having the condition. Older adults with diabetes face higher mortality, reduced functional status, and increased institutionalization risks. Despite high prevalence, older adults are often excluded from clinical trials, complicating treatment strategies. The American Diabetes Association convened a conference to address diabetes in older adults, highlighting the need for individualized care. Epidemiologically, diabetes prevalence in older adults varies from 22 to 33%, with postprandial hyperglycemia being common. Type 2 diabetes is linked to aging, obesity, and increased prevalence. Older adults with diabetes have higher rates of complications like amputations, MI, and renal disease. Screening for diabetes and prediabetes is recommended for high-risk individuals, with evidence supporting early intervention. Prevention and treatment of diabetes in older adults involve lifestyle interventions and medications. The Diabetes Prevention Program showed lifestyle interventions were effective in older participants, though metformin had limited benefits. Glycemic control studies, such as UKPDS, ADVANCE, and VADT, show mixed results, with some indicating benefits and others showing no significant effect. Intensive glycemic control in older adults may increase risks, especially for those with long diabetes duration. Lipid-lowering therapies like statins are beneficial for older adults with diabetes, especially for cardiovascular prevention. Blood pressure control is also important, with targets like <140 mmHg for SBP. Aspirin is recommended for older adults with diabetes and CVD, though risks of bleeding must be considered. Screening for chronic complications is essential, with individualized approaches based on patient characteristics. Guidelines from the ADA and other organizations suggest individualized glycemic targets, considering comorbidities and life expectancy. For example, A1C targets may be less strict for those with limited life expectancy or advanced complications. Comorbidities and geriatric syndromes, such as cognitive dysfunction, functional impairment, and falls, are common in older adults with diabetes. These conditions require tailored management, including simplified regimens, caregiver involvement, and regular assessments. Nutrition is crucial, with older adults at risk for deficiencies due to reduced caloric intake. MNT is recommended, considering cultural and personal preferences. Physical activity is beneficial, with even light-intensity exercise improving health outcomes. Pharmacotherapy in older adults requires careful consideration of drug interactions, renal function, and hypoglycemia risks. Metformin is often first-line, but other medications like sulfonylureas and glinides have higher hypoglycemia risks. Insulin therapy is used when appropriate, with careful monitoring of hypoglycemia. Overall, individualized care is essential for older adults with diabetes, considering their unique health status, comorbidities, and life expectancy. This approach ensures effective management of diabetes and its complications while minimizing risks.