Frailty, rather than age, determines the prognosis for older adults with diabetes, and should therefore be a key determinant of target setting and treatment choices when individualising care.

Frailty-dependent glycaemic treatment targets and de-escalation thresholds have previously been described and are generally accepted.

There is a lack of formal guidance for healthcare professionals on the best routes to achieve these targets.

We summarise here the relative merits of various drug classes as they pertain to older adults with diabetes and recommend simple glycaemic management algorithms according to their level of frailty.