Appropriate application of evidence to the care of elderly patients with diabetes.

Modern diabetes care may benefit a significant proportion of adults living with diabetes; however, these benefits may not be consistently realized among the heterogeneous subpopulation of elderly patients over 65 years of age. There are three clinical constraints that have been proposed as important considerations for individualizing diabetes care among elderly patients. Life expectancy should be an important determinant of the intensity of glucose control because intensive control has been found to prevent complications only after extended periods of treatment. Therefore, patients with limited life expectancy may not benefit from intensive glucose control. The time and attention of health care providers should also be considered a constrained resource that can be optimally allocated to care for elderly diabetes patients. In the face of multiple chronic conditions and symptomatic complaints, patients and their providers should prioritize diabetes care within the context of a patient's overall health care plan. The complexity of chronic medications or polypharmacy is the final clinical constraint. Polypharmacy may increase the probability of adverse drug events and represent a significant burden on quality of life. More direct clinical investigation of elderly diabetes patients will be needed if we are to truly improve the quality of life of this growing subpopulation.