Challenges and Opportunities for Improving Care for Type 1 Diabetes in Older Adulthood

作者：Anna R. Kahkoska, Joshua J. Neumiller, Anastasia‐Stefania Alexopoulos, Amlan Barik, Elbert S. Huang, Lori M. Laffel, Naushira Pandya, Christine Slyne, Elena Toschi, Ruth S. Weinstock, Medha N. Munshi · 发表于：Diabetes Care · 年份：2025 · DOI：10.2337/dci25-0078 · 被引用次数：5 · 研究领域：Diabetes Management and Research、Diabetes and associated disorders、Diabetes Treatment and Management

As care for type 1 diabetes (T1D) advances, the number of adults with T1D living into older adulthood (ages ≥65 years) continues to grow. The population of older adults with T1D is highly heterogeneous, and over the life span, various factors may change over time while others may not, necessitating an individualized approach to management. A key care consideration for people with T1D is the ongoing need for exogenous insulin replacement intensive self-monitoring for effective management. At the same time, growing older may bring changes such as increased risk of misdiagnosis of T1D as type 2 diabetes, greater vulnerability to hypoglycemia, accumulating comorbidities and complications, declining independence due to geriatric syndromes, and a growing need for support in using diabetes technologies and navigating complex care transitions. Given the unique clinical and management needs of this population, we sought to present key care challenges in this population and suggest strategies to optimize quality of care in older adults with T1D, including 1) integrating geriatric screenings, age-friendly care frameworks, and regular reassessments into routine T1D management; 2) developing tailored care approaches for cognitive impairment; 3) establishing support systems for diabetes technology use in primary and long-term care settings; and 4) ensuring insurance coverage and access to diabetes technologies and therapies. Forward-thinking strategies to optimize care include individualiz...