Table 3.

Consensus recommendations for research questions about diabetes in older adults

What specific cellular and molecular mechanisms define the interactions between aging and lifestyle factors that underlie the high rates of diabetes in the older adult population? How can such mechanisms be used to develop effective intervention strategies?

How does aging affect the trajectories of development of macro-and microvascular complications over time?

What are the best interventions to prevent type 2 diabetes in older adults? How can evidence-based lifestyle intervention strategies be implemented widely in the community in ways that maximize participation of older adults?

More studies of the mechanisms of the link between diabetes and cognitive impairment should be conducted. Many diabetes trials that include older adults should include assessment of cognition as a covariate or outcome. Does treatment of hyperglycemia in general or via particular strategies reduce the risk of diabetes-associated cognitive impairment? Is such cognitive impairment slowed or prevented by diabetes prevention strategies?

What is the optimal level of blood pressure control in older adults with diabetes? What are the best treatment strategies?

Do specific diabetes interventions prevent or slow decline in functional status in older adults?

How can fall risk be reduced in older adults with diabetes?

Can we make it easier for clinicians to anticipate expected lifetime benefit of interventions, such as decision support tools for life expectancy embedded in electronic health records? What impact will formal use of prognostic information have on diabetes care and patient outcomes?

What aspects of patient-provider communication are most effective in shared decision making with older patients and caregivers?

What are the ethical and patient preference concerns about de-intensifying therapy in older adults who are deemed unlikely to reap benefit from aggressive therapy of diabetes and its comorbidities?

Comparative effectiveness studies of diabetes therapies in older adults should be undertaken. Does comparative effectiveness differ for older vs. younger adults?

What are the health literacy/numeracy issues in this population and how can they best be addressed?

What is the true incidence of hypoglycemia in older adults? How can it be recognized and reduced? What are the mechanisms of the bidirectional association of severe hypoglycemia with cognitive impairment? Is the relationship of hypoglycemia to cardiovascular outcomes a direct cause/effect, or more complex?

What is the impact of geriatric syndromes on the management of diabetes, and on risk for adverse treatment effects and poor outcomes?

What are significant race/ethnic disparities among older adults with diabetes, and what are best approaches to addressing them?

What strategies are effective for increasing physical activity in older adults with diabetes? What are the effects of exercise on clinical and psychosocial outcomes?

Is there evidence that intentional weight loss is beneficial in overweight older adults with diabetes?

What are the best strategies for DSME/S in older adults? What are the roles of technology, group vs. individual education, and support by community resources?

What are the unique stressors of caregivers of these older adults with diabetes, and how can they be addressed?

What are the mechanisms of the impact of diabetes and specific therapies on bone health?

What is the expected time frame of benefit of diabetes interventions, including complications screening and care? Such studies will likely require use of longitudinal studies and registries, rather than randomized controlled trials.

What is the appropriate frequency and cost-effectiveness of SMBG in heterogeneous older adults with diabetes?

Studies of older patients in hospitals and LTC facilities are greatly needed. What are appropriate treatment goals and strategies for these populations? How can transitions of care (such as between hospital and LTC facility) be optimized to maximize patient safety? Will system changes such as Accountable Care Organizations improve outcomes in vulnerable older adults?