Abstract

Diabetes mellitus is an increasingly prevalent chronic condition among elderly populations worldwide, driven 
largely by demographic aging and improved life expectancy. Older adults with diabetes represent a heterogeneous 
group with diverse clinical profiles, comorbidities, functional capacities, and care needs. Age-related physiological 
changes, including progressive insulin resistance, β-cell dysfunction, and altered glucose homeostasis, complicate 
both the presentation and management of diabetes in this population. Furthermore, atypical symptomatology, 
multimorbidity, polypharmacy, and heightened vulnerability to hypoglycemia and frailty pose significant clinical 
challenges. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, diagnostic 
considerations, and management strategies for diabetes in elderly populations. Particular emphasis is placed on 
geriatric-specific concerns, including cognitive and functional impairment, hypoglycemia risk, health-related 
quality of life, and the impact of comorbidities. Pharmacologic and non-pharmacologic interventions are discussed 
within the context of individualized, patient-centered care, highlighting the importance of balancing glycemic 
targets with safety and functional preservation. The review also explores emerging health system models and 
multidisciplinary care approaches designed to address the complex needs of older adults with diabetes. Despite the 
growing disease burden, elderly individuals remain underrepresented in clinical research, resulting in limited 
evidence to guide optimal care. Future directions emphasize the need for flexible treatment frameworks, 
integration of geriatric assessments, and a paradigm shift toward healthy longevity and quality-of-life–focused 
outcomes. Addressing these gaps is essential to improving diabetes care and outcomes in aging populations.