Table 1.

Factors influencing suboptimal diabetes care in older adults and strategies for improvement

Factors	Strategies
Heterogeneity of older adults	Implement individualized care plans based on frailty levels, functional status, life expectancy, comorbidities, and patient preferences
Different metabolic phenotypes	The spectrum includes two key metabolic phenotypes in frail older adults with diabetes: “anorexic malnourished” (AM), marked by undernutrition and muscle loss, and “sarcopenic obese” (SO), characterized by excess fat and reduced muscle mass. These extremes underscore the need for tailored management strategies
Risk of hypoglycaemia	Adjust glycaemic targets (e.g., HbA1c 7.5–8.0% for frail individuals) and avoid medications with high hypoglycaemia risks, such as sulfonylureas
Cognitive decline and physical impairments	Simplify treatment regimens, involve caregivers in care plans, and use long-acting medications or devices to reduce the complexity of diabetes self-management
Polypharmacy and medication interactions	Regularly review medication lists to minimize non-essential drugs, reduce interactions, and optimize medication regimens tailored to the patient’s needs
Comorbidities	Integrate diabetes management with care for other chronic conditions, prioritizing medications with dual benefits (e.g., SGLT2 inhibitors for heart failure or nephropathy)
Limited access to multidisciplinary care	Enhance access to geriatric care teams, including endocrinologists, dietitians, and social workers, to provide comprehensive and coordinated care
Inadequate patient and caregiver education	Empower patients and caregivers through education about self-management, recognizing symptoms of complications, and optimizing lifestyle interventions
Healthcare system barriers	Foster integrated care models and implement telemedicine or community-based services to improve access and continuity of care
Socioeconomic challenges	Advocate for affordable medications, provide social support programs, and address social determinants of health to improve adherence and outcomes
Inadequate focus on preventive care	Prioritize vaccination, routine screening (e.g., foot and eye exams), for geriatric syndromes and early intervention to reduce the risk of complications and hospitalizations

HbA1c hemoglobin A1c, SGLT2 sodium-glucose cotransporter-2 inhibitors