Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Patients with symptoms of claudication, decreased, or absent pedal pulses should be referred for ABI & further vascular assessment. C

• Patients with symptoms of claudication, decreased, or absent pedal pulses should be referred for ABI & further vascular assessment. C

• A multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet. B

• The use of specialized therapeutic footwear is recommended for patients with high-risk feet. B

Refer patients who smoke or who have hx of lower-extremity complications, loss of protective sensation, structural abnormalities or PAD to foot care specialists for ongoing preventive care and lifelong surveillance. C

• Refer patients who smoke or who have hx of lower-extremity complications, loss of protective sensation, structural abnormalities or PAD to foot care specialists for ongoing preventive care and lifelong surveillance. C

• Provide general foot self-care education to all patients with diabetes. B

26% of patients aged >65 have diabetes.

• 26% of patients aged >65 have diabetes.

• Older adults have higher rates of premature death, functional disability & coexisting illnesses.

• At greater risk for polypharmacy, cognitive impairment, urinary incontinence, injurious falls & persistent pain.

• Screening for complications should be individualized and periodically revisited.

• At higher risk for depression

Functional, cognitively intact older adults (≥65 years of age) with significant life expectancy should receive diabetes care using goals developed for younger adults. C

• Functional, cognitively intact older adults (≥65 years of age) with significant life expectancy should receive diabetes care using goals developed for younger adults. C

• Determine targets & therapeutic approaches by assessment of medical, functional, mental, and social geriatric domains for diabetes management. C

Glycemic goals for some older adults might be relaxed but hyperglycemia leading to symptoms or risk of acute hyperglycemic complications should be avoided in all patients. C

• Glycemic goals for some older adults might be relaxed but hyperglycemia leading to symptoms or risk of acute hyperglycemic complications should be avoided in all patients. C

• Hypoglycemia should be avoided in older adults with diabetes. It should be screened for and managed by adjusting glycemic targets and pharmacologic interventions. B

Patients with DM in long-term care facilities need careful assessment to establish a glycemic goal & to make appropriate choices of glucose-lowering agents. E

• Patients with DM in long-term care facilities need careful assessment to establish a glycemic goal & to make appropriate choices of glucose-lowering agents. E

• Other CV risk factors should be treated in older adults with consideration of the time frame of benefit and the individual patient. E

• Treatment of HTN is indicated in most older adults C
• Lipid-lowering and aspirin therapy may benefit those with life expectancy at least equal to the time frame of primary or secondary prevention trials. E

When palliative care is needed, strict BP control may not be necessary and withdrawal of therapy may be appropriate. Intensity of lipid management can be relaxed and withdrawal of lipid-lowering therapy may be appropriate. E

• When palliative care is needed, strict BP control may not be necessary and withdrawal of therapy may be appropriate. Intensity of lipid management can be relaxed and withdrawal of lipid-lowering therapy may be appropriate. E

• Screening for complications should be individualized, but attention should be paid to complications that would lead to functional impairment. C

Screening for geriatric syndromes may be appropriate in older adults with limitations in basic and instrumental activities of daily living. C

• Screening for geriatric syndromes may be appropriate in older adults with limitations in basic and instrumental activities of daily living. C

• Older adults with DM should be considered a high-priority population for depression screening and treatment. B

• Annual screening for early detection of mild cognitive impairment or dementia is indicated for adults 65 years of age or older. B

Consider diabetes education for long-term care facility staff. E

• Consider diabetes education for long-term care facility staff. E

• Overall comfort, prevention of distressing symptoms & preservation of quality of life and dignity are primary goals for diabetes management at the end of life. E

¾ of all cases of T1DM are dx’d in patients <18 yrs.

• ¾ of all cases of T1DM are dx’d in patients <18 yrs.

• Providers must consider many unique aspects to care & mgmt. of children & adolescents with T1DM.

• Attention to family dynamics, developmental stages, physiological differences is essential.

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