A Position Statement on Management of Diabetes in Older Adults

The rapid transition of Korea into a super-aged society is accompanied by a significant increase in the prevalence of diabetes among older adults, which now stands at 29.4% for those aged 65 and above. The management of diabetes in this older population is complex, necessitating individualized therapeutic approaches due to the intricate interactions among aging, multimorbidity, frailty, and functional decline. Application of standard diabetes guidelines developed for younger adults may be inappropriate and even harmful when applied directly to older patients. This position statement emphasizes the integration of a comprehensive geriatric assessment and frailty screening to guide personalized treatment strategies. Glycemic targets should prioritize avoidance of hypoglycemia and enhancement of quality of life, while considering cognitive status, functional ability, and life expectancy. Lifestyle management should include tailored nutritional support and safe physical activity, with a focus on preventing sarcopenia and malnutrition. Pharmacological regimens should be simplified, prioritizing agents with low risk of hypoglycemia. The use of continuous glucose monitoring is recognized for its potential to improve safety and glycemic control in selected older patients. Specialized care plans are essential for residents in long-term care facilities and individuals at end-of-life stages, where care goals should shift to emphasize comfort, safety, and individualized goals. This position statement calls for policy support, clinician education, and targeted research to optimize care and improve outcomes for the growing population of older adults with diabetes.