DM in older adults

Which HbA1c target is most appropriate for a frail older adult with multiple comorbidities and limited life expectancy?

• <6.5%
• <7.0%
• <7.5%
• <8.5%

Answer explanation

Higher targets (e.g. <8.5%) help avoid hypoglycemia and overtreatment in frail elders.

Which class of antidiabetic medication carries the highest risk of hypoglycemia in older adults?

• DPP-4 inhibitors
• SGLT2 inhibitors
• Sulfonylureas
• Metformin

Answer explanation

Sulfonylureas, especially long-acting ones, can cause severe hypoglycemia.

What is the first-line pharmacologic treatment for type 2 diabetes in older adults with preserved renal function?

• Insulin
• Metformin
• Sulfonylurea
• Pioglitazone

Answer explanation

Metformin is recommended first-line if renal function is good.

Which of the following is an important consideration when using SGLT2 inhibitors in older adults?

• Risk of urinary tract infections and dehydration
• Liver enzyme monitoring
• Severe hypoglycemia
• Increased appetite

Answer explanation

Dehydration and genitourinary infections are associated risks.

According to the ADA, which is a recommended component of diabetes care in older adults?

• Annual dental exam only
• Avoid all pharmacotherapy if HbA1c is <8%
• Individualized glycemic targets based on comorbidities and function
• Tight control with insulin for all patients

Answer explanation

Goals must be tailored considering comorbidities and overall health.

What is a common barrier to insulin use in older adults?

• Low cost
• Lack of efficacy
• Visual and cognitive impairment
• Improved appetite

Answer explanation

Such impairments may hamper safe self-administration of insulin.

Abigail, a 70-year-old woman with diabetes and a history of heart disease, visits her doctor for a routine check-up. During the visit, her doctor discusses the importance of managing her blood pressure to reduce her cardiovascular risk. What is the most appropriate blood pressure target for older adults like Abigail with diabetes and high cardiovascular risk?

• <160/100 mmHg

• <150/90 mmHg

• <140/90 mmHg

• <120/80 mmHg

Answer explanation

Standard guideline target: <140/90 mmHg for high-risk patients.

In an older adult with mild dementia and diabetes, what is a priority in diabetes care?

• Initiate basal-bolus insulin
• Reduce HbA1c to <6.5%
• Prevent hypoglycemia and simplify regimen
• Add SGLT2 inhibitor for weight loss

Answer explanation

Simplifying therapy and avoiding hypoglycemia is key in dementia.

Which symptom in an older diabetic patient may indicate hypoglycemia?

• Sweating
• Palpitations
• Confusion or behavioral change
• Tremor

Answer explanation

Cognitive/behavioral changes are common hypoglycemia signs in elders.

What is a key non-pharmacologic intervention for older adults with type 2 diabetes?

• High-protein ketogenic diet
• Regular strength and balance exercises
• Fluid restriction
• Avoid carbohydrates completely

Answer explanation

Exercise supports glycemic control and helps prevent falls/fractures.