Diabetes and Aging: Meeting the Needs of a Burgeoning Epidemic in the United States.

Abstract-In the United States, one out of every four adults over the age of 65 has diabetes and one half of all adults in this age group are prediabetic, placing them at high risk for developing the disease. Beyond the United States, many other countries are also facing aging populations and high obesity rates that contribute to a staggering global diabetes epidemic. The care of the older patient with diabetes is frequently challenging, due to the accumulation of diabetic complications, extensive comorbidities, and functional impairments. Compounding this challenge is the lack of directly available evidence to guide management and care in this population. Though the global community shares in the epidemiologic burden of diabetes, there are large disparities across health systems and nations in the allocation of resources to the prevention, diagnosis, and treatment of the disease. Yet there is a consistency across many countries in the sub-optimal glycemic control and health outcomes for a majority of diabetics. This article reviews the context in which health systems provide diabetes care for the elderly and provides a framework for policy makers to support comprehensive diabetes care in the older adult. Nearly half of global diabetes expenditures occur in the United States, where only 6% of the world's diabetics reside. This article focuses on how to improve diabetes care in the United States, given its disproportionate contribution to global diabetes expenditures. Many of the recommendations presented, however, may be adapted and applied to other health systems.