Ajay Sood, MD, Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine; Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland, OH, USA.
David C. Aron, MD, MS, Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine; VA Network 10 Geriatric Research, Education, and Clinical Centers, VA Health Services Research and Development Quality Enhancement Research Initiative Diabetes Clinical Coordinating Center; Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.

Glycemic goals and the decision to intensify glycemic control among older adults with diabetes must be individualized based on comorbid conditions and the risks associated with treatment. The duration of diabetes mellitus, baseline glycosylated hemoglobin value, prior history of cardiovascular disease, and history of severe hypoglycemia are important factors to consider. This article reviews how the management of diabetes mellitus in this subgroup is changing in view of three recently reported randomized trials of intensive glycemic control.
Key words: diabetes, older adults, glycemic control, cardiovascular disease, glycemic goal.

Alissa R. Segal, PharmD, CDE, Associate Professor, Massachusetts College of Pharmacy and Health Sciences; Clinical pharmacist, Joslin Diabetes Center, Boston, Massachusetts, U.S.A.
Medha N. Munshi, MD, Assistant Professor, Harvard Medical School; Director of Joslin
Geriatric Diabetes Program, Joslin Diabetes Center; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A.

The aging of the population and increasing prevalence of diabetes are worldwide phenomena that require a better focus on challenges of diabetes management in older adults. We now understand the benefits of tight glycemic control and have an armament of agents to achieve such a feat. However, in an aging population, balance must be sought between the goals of glycemic control and those of overall health status, including quality of life. Insulin therapy, in particular, requires significant self-care abilities. Insulin therapy can be used safely and effectively if diabetes management plans are formulated with consideration of the clinical, functional, and psychosocial contexts of an older adult.
Key words: diabetes, older adults, insulin therapy, geriatrics, glycemic control.

Daniel Tessier, MD, MSc, FRCPC, CSPQ
Sherbrooke Geriatric University Institute
Associate Professor, Faculty of Medicine
University of Sherbrooke

Introduction
The most recent Health and Nutrition survey in the United States demonstrated that the prevalence of diabetes is approaching 20% in Caucasian patients over the age of 70, and in certain ethnic groups, may be as high as 50%.¹ Currently, the over 65 age group represents about 13 % of the total population, a percentage which is expected, by the year 2020, to increase to approximately 21% of the population. The majority of elderly diabetic patients have type 2 diabetes mellitus (DM), characterized by a gradually increasing glycemia that results from a combination of a resistance, at the cellular level, to the action of insulin, and a gradual decline of insulin secretion by the pancreas. A few years of asymptomatic disease may have elapsed prior to the diagnosis of DM being made, especially in the case of elderly patients. The following article will provide a brief review of the acute complications related to DM in the elderly with a particular focus on the evolution of the disease, side effects of treatment, and the vascular problems and acute infections that are often associated with this health problem.