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The three case studies presented here by Diabetes & Primary Care take you through the complexities of managing type 2 diabetes in elderly people who require differing levels of care. The scenarios provide different sets of circumstances that you could meet in your everyday practice. By actively engaging with them, you will feel more confident and empowered to manage such presentations effectively in the future.

(Prepared in December 2022)


  1. International Diabetes Federation (2017) Managing older people with type 2 diabetes. IDF, Brussels, Belgium.
  2. Hambling CE, Khunti K, Cos X et al (2019) Factors influencing safe glucose-lowering in older adults with type 2 diabetes: a position statement of Primary Care Diabetes Europe. Prim Care Diabetes 13: 730–2
  3. ADA (2022) Section 13: Older adults: Standards of Medical Care in Diabetes–2022. Diabetes Care 45: S195–207
  4. Strain WD, Down S, Brown P et al (2021) Diabetes and frailty: an expert consensus statement on the management of older adults with type 2 diabetes. Diabetes Ther 12: 1227–47
  5. ADA (2022) Section 6: Glycaemic targets: Standards of Medical Care in Diabetes–2022. Diabetes Care 45: S125–43
  6. Forbes A, Murrells T, Mulnier H, Sinclair A (2018) Mean HbA1c, HbA1c variability and mortality in people with diabetes aged 70 years and older: a retrospective cohort study. Lancet Diabetes Endocrinol 6: 476–86
  7. Hambling C (2020) How to manage diabetes in later life. Diabetes & Primary Care 22: 5–6;
  8. Heller SR (2011) Hypoglycaemia: Its pathophysiology in insulin treated diabetes and hypoglycaemic awareness. The British Journal of Diabetes & Vascular Disease 11(Suppl 1): 6–11
  9. Khunti K, Davies M , Majeed A et al (2014) Hypoglycaemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care 38: 316–22
  10. Farmer AJ, Brockbank KJ, Keech ML et al (2012) Incidence and costs of severe hypoglycaemia requiring attendance by the emergency medical services in South Central England. Diabet Med 29: 1447–50
  11. SIGN (2017) Pharmacological management of glycaemic control in people with type 2 diabetes (SIGN 154).
  12. Davies MJ, Aroda VR, Collins BS et al (2022) Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and European Association for the study of diabetes (EASD). Diabetologia 65: 1925–66
  13. NICE (2022) Type 2 diabetes in adults: management (NG28).
  14. Filipova E, Uzunova K, Kalinov, K, Vekov T (2017) Pioglitazone and risk of bladder cancer: a meta-analysis. Diabet Ther 8: 705–26
  15. Heerspink HJL, Stephánsson BV, Correa-Rotter R et al; DAPA-CKD trial Committees and Investigators (2002) Dapagliflozin in patients with chronic kidney disease. N Engl J Med 383: 1436­–46
  16. Holman RR, Paul SK, Bethel MA et al (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359: 1577–89
  17. Schwartz AV, Hillier TA, Selleyer DE et al (2002) Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care 25: 1749–54
  18. Cheng G, Huang C, Deng G, Wang H (2012) Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med 42: 484–91
  19. Maraldi C, Volpato S, Penninx BW et al (2007) Diabetes mellitus, glycaemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study. Arch Intern Med 167: 1137–44
  20. Gadsby R (2018) Diabetes care for older people: A practical view on management. Diabetes & Primary Care 20: 27–37;

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