Diabetes Management in Older Adults With Chronic Kidney Disease

  • Kristin K. ClemensEmail author
  • Niamh O’Regan
  • Jinnie J. Rhee
Microvascular Complications—Nephropathy (M Afkarian and B Roshanravan, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Microvascular Complications—Nephropathy


Purpose of Review

Older adults often live with chronic disease including diabetes and its complications. In this review, we examine the complexity and heterogeneity of older adults with diabetes and chronic kidney disease, explore the nuances in their diabetes-related monitoring, and discuss their best diabetes management.

Recent Findings

Although there remains an overall lack of studies in older adults with diabetes and chronic kidney disease, recent reports have highlighted their vulnerabilities. These individuals face an increased risk of cognitive impairment and dementia, frailty, dysglycemia, polypharmacy, declining kidney function, and acute kidney injury. Their diabetes management should focus upon safer antihyperglycemic medications, close monitoring, and care individualization.


Older adults with diabetes and chronic kidney disease are a complex population who requires careful diabetes management and monitoring. Research efforts might focus on improving the care and outcomes of these patients.


Diabetes Older adults Chronic kidney disease Antihyperglycemic medications Frailty Hypoglycemia Comorbidity 


Funding Information

Kristin K. Clemens reports grants from the Canadian Institutes of Health Research/Strategy for Patient Oriented Research and grants from Western University. Niamh O’Regan reports a grant from the Academic Medical Organization of Southwestern Ontario. Jinnie J. Rhee reports grants from National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (K01 Research Scientist Career Development Award).

Compliance with Ethical Standards

Conflict of Interest

Kristin K. Clemens received a 2017 Diabetes Canada Junior Investigator Award funded by AstraZeneca outside of the submitted work. She has also received conference support from Merck Inc.

Niamh O’Regan and Jinnie J. Rhee declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    World Health Organization. Number of people over 60 years set to double by 2050; major societal changes required. 2015. Available from: Accessed 17 Sept 2018.
  2. 2.
    Stevens LA, Viswanathan G, Weiner DE. Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence, future projections, and clinical significance. Adv Chronic Kidney Dis. 2010;17(4):293–301.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    USRDS. CKD in the general population. 2017. Available from: Accessed 18 Sept 2018.
  4. 4.
    Lloyd A, Komenda P. Optimizing care for Canadians with diabetic nephropathy in 2015. Can J Diabetes. 2015;39(3):221–8. Available from: Accessed 1 Sept 2018
  5. 5.
    Clemens KK, Ouedraogo A, Nash DM, Garg AXSS. The health and healthcare of adults with type 1 and 2 diabetes across the estimated glomerular filtration rate spectrum. Can J Diabetes. 2018;S1499–2671(18):30148–5.Google Scholar
  6. 6.
    Lau DCW. Diabetes in the elderly: a silent global tsunami. Can J Diabetes. 2016;40(1):2–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Pal K, Mukadam N, Petersen I, Cooper C. Mild cognitive impairment and progression to dementia in people with diabetes, prediabetes and metabolic syndrome: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2018 Sep 4; Available from: Accessed 26 Sept 2018.
  8. 8.
    Biessels GJ, Strachan MWJ, Visseren FLJ, Kappelle LJ, Whitmer RA. Dementia and cognitive decline in type 2 diabetes and prediabetic stages: towards targeted interventions. Lancet Diabetes Endocrinol. 2014;2(3):246–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Ma F, Wu T, Miao R, Xiao, Yyu, Zhang W, Huang G. Conversion of mild cognitive impairment to dementia among subjects with diabetes: a population-based study of incidence and risk factors with five years of follow-up. J Alzheimers Dis. 2014;43(4):1441–9. Available from: Accessed 26 Sept 2018.
  10. 10.
    Kurella M, Chertow GM, Luan J, Yaffe K. Cognitive impairment in chronic kidney disease. J Am Geriatr Soc. 2004;52(11):1863–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Palmer ND, Sink KM, Smith SC, Xu J, Bowden DW, Hugenschmidt CE, et al. Kidney disease and cognitive function: African American-Diabetes Heart Study MIND. Am J Nephrol. 2014;40(3):200–7. Available from: Accessed 26 Sept 2018.
  12. 12.
    Yaffe K, Ackerson L, Tamura MK, Le Blanc P, Kusek JW, Sehgal AR, et al. Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study. J Am Geriatr Soc. 2010;58(2):338–45.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Tamura MK, Muntner P, Wadley V, Cushman M, Zakai NA, Bradbury BD, et al. Albuminuria, kidney function, and the incidence of cognitive impairment among adults in the United States. Am J Kidney Dis. 2011;58(5):756–63.PubMedCentralCrossRefGoogle Scholar
  14. 14.
    Kurella Tamura M, Unruh ML, Nissenson AR, Larive B, Eggers PW, Gassman J, et al. Effect of more frequent hemodialysis on cognitive function in the frequent hemodialysis network trials. Am J Kidney Dis. 2013;61(2):228–37.PubMedCrossRefGoogle Scholar
  15. 15.
    Yin Z, Yan Z, Liang Y, Jiang H, Cai C, Song A, et al. Interactive effects of diabetes and impaired kidney function on cognitive performance in old age: a population-based study. BMC Geriatr. 2016;16:7.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Santos FRM, Bernardo V, Gabbay MAL, Dib SA, Sigulem D. The impact of knowledge about diabetes, resilience and depression on glycemic control: a cross-sectional study among adolescents and young adults with type 1 diabetes. Diabetol Metab Syndr. 2013;5(1) (no(55). Available from:, Accessed 1 Sept 2018.
  17. 17.
    •• Strain WD, Hope S V., Green A, Kar P, Valabhji J, Sinclair AJ. Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative. Diabet Med [Internet]. 2018 Jul [cited 2018 Sep 26];35(7):838–45. Available from: This paper provides excellent recommendations for the assessment and management of frailty in older patients.
  18. 18.
    Sinclair AJ, Abdelhafiz AH, Rodríguez-Mañas L. Frailty and sarcopenia—newly emerging and high impact complications of diabetes. J Diabetes Complicat. 2017;31(9):1465–73.PubMedCrossRefGoogle Scholar
  19. 19.
    Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Singh MAF. Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. Am J Clin Nutr. 2002;76(2):473–81.PubMedCrossRefGoogle Scholar
  20. 20.
    Kane AE, Gregson E, Theou O, Rockwood K, Howlett SE. The association between frailty, the metabolic syndrome, and mortality over the lifespan. GeroScience. 2017;39(2):221–9.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, et al. Frailty: an emerging research and clinical paradigm—issues and controversies. J Gerontol A Biol Sci Med Sci. 2007;62(7):731–7.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Adame Perez SI, Senior PA, Field CJ, Jindal K, Mager DR. Frailty, health-related quality of life, cognition, depression, vitamin d and health-care utilization in an ambulatory adult population with type 1 or type 2 diabetes mellitus and chronic kidney disease: a cross-sectional analysis. Can J Diabetes. 2018 Available from: Accessed 1 Sept 2018.
  24. 24.
    Roshanravan B, Zelnick LR, Djucovic D, Gu H, Alvarez JA, Ziegler TR, et al. Chronic kidney disease attenuates the plasma metabolome response to insulin. JCI Insight. 2018;3(16). Available from: Accessed 10 Dec 2018.
  25. 25.
    Thein FS, Li Y, Nyunt MSZ, Gao Q, Wee SL, Ng TP. Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality. Postgrad Med. 2018;130(6):561–7. Available from: Accessed 26 Sept 2018.
  26. 26.
    Roshanravan B, Khatri M, Robinson-Cohen C, Levin G, Patel K V, de Boer IH, et al. A prospective study of frailty in nephrology-referred patients with CKD. Am J Kidney Dis. 2012;60(6):912–21. Available from: Accessed 10 Dec 2018.
  27. 27.
    de Boer IH, Zelnick L, Afkarian M, Ayers E, Curtin L, Himmelfarb J, et al. Impaired glucose and insulin homeostasis in moderate-severe CKD. J Am Soc Nephrol. 2016;27(9):2861–71. Available from: Accessed 8 Dec 2018.
  28. 28.
    Kovesdy CP, Park JC, Kalantar-Zadeh K. Glycemic control and burnt-out diabetes in ESRD. Semin Dial. 2010;23(2):148–56.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Kovesdy CP, Sharma K, Kalantar-Zadeh K. Glycemic control in diabetic CKD patients: where do we stand? Am J Kidney Dis. 2008;52(4):766–77. Available from: Accessed 10 Sep 2018.
  30. 30.
    Rhee CM, Leung AM, Kovesdy CP, Lynch KE, Brent GA, Kalantar-Zadeh K. Updates on the management of diabetes in dialysis patients. Semin Dial. 2014;27(2):135–45.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Hodge M, McArthur E, Garg AX, Tangri NCK. Hypoglycemia risk by estimated glomerular filtration rate. Am J Kidney Dis. 2016;70(1):59–68.CrossRefGoogle Scholar
  32. 32.
    Moen MF, Zhan M, Hsu VD, Walker LD, Einhorn LM, Seliger SL, et al. Frequency of hypoglycemia and its significance in chronic kidney disease. Clin J Am Soc Nephrol. 2009;4(6):1121–7.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Biesenbach G, Raml A, Schmekal B, Eichbauer-Sturm G. Decreased insulin requirement in relation to GFR in nephropathic type 1 and insulin-treated type 2 diabetic patients. Diabet Med. 2003;20(8):642–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Torffvit O, Lindqvist A, Agardh CD, Pahlm O. The association between diabetic nephropathy and autonomic nerve function in type 1 diabetic patients. Scand J Clin Lab Invest. 1997;57(2):183–91.Google Scholar
  35. 35.
    Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R, et al. Frequency and predictors of hypoglycaemia in type 1 and insulin-treated type 2 diabetes: a population-based study. Diabet Med. 2005;22(6):749–55. Available from: Accessed 10 Jul 2018.
  36. 36.
    Ciudin A, Espinosa A, Simó-Servat O, Ruiz A, Alegret M, Hernández C, et al. Type 2 diabetes is an independent risk factor for dementia conversion in patients with mild cognitive impairment. J Diabetes Complicat. 2017;31(8):1272–4.PubMedCrossRefGoogle Scholar
  37. 37.
    De Galan BE, Zoungas S, Chalmers J, Anderson C, Dufouil C, Pillai A, et al. Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with type 2 diabetes: The action in diabetes and vascular disease: preterax and diamicron modified release controlled evaluation (ADVANCE) trial. Diabetologia. 2009;52(11):2328–36.PubMedCrossRefGoogle Scholar
  38. 38.
    Geller AI, Shehab N, Lovegrove MC, Kegler SR, Weidenbach KN, Ryan GJ, et al. National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Intern Med. 2014;174(5):678–86.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Garber AJ, Bier DM, Cryer PE, Pagliara AS. Hypoglycemia in compensated chronic renal insufficiency. Substrate limitation of gluconeogenesis. Diabetes. 1974;23(12):982–6. Available from: Accessed 14 Jul 2016.
  40. 40.
    Woerle HJ, Meyer C, Popa EM, Cryer PE, Gerich JE. Renal compensation for impaired hepatic glucose release during hypoglycemia in type 2 diabetes: further evidence for hepatorenal reciprocity. Diabetes. 2003;52(6):1386–92.PubMedCrossRefGoogle Scholar
  41. 41.
    Alsahli M, Gerich JE. Hypoglycemia in patients with diabetes and renal disease. J Clin Med [Internet]. 2015 Jan 1 [cited 2016 Jan 18];4(5):948–64. Available from:
  42. 42.
    Bremer JP, Jauch-Chara K, Hallschmid M, Schmid S, Schultes B. Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care. 2009;32(8):1513–7.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Frier BM. Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications. Nat Rev Endocrinol. 2014;10(12):711–22. Available from: Accessed 8 Oct 2014.
  44. 44.
    Dörks M, Herget-Rosenthal S, Schmiemann G, Hoffmann F. Polypharmacy and renal failure in nursing home residents: results of the Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes (IMREN) Study. Drugs Aging. 2016;33(1):45–51.PubMedCrossRefGoogle Scholar
  45. 45.
    Ahmed B, Nanji K, Mujeeb R, Patel MJ. Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study. PLoS One. 2014;9(11):e112133.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Williams ME. Diabetic kidney disease in elderly individuals. Med Clin N Am. 2013;97(1):75–89.PubMedCrossRefGoogle Scholar
  47. 47.
    Miller KM, Foster NC, Beck RW, Bergensta RM, DuBose SN, DiMeglio LA, et al. Current state of type 1 diabetes treatment in the U.S.: updated data from the t1d exchange clinic registry. Diabetes Care. 2015;38(6):971–8.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Jacobs A, Benraad C, Wetzels J, Rikkert MO, Kramers C. Clinical relevance of differences in glomerular filtration rate estimations in frail older people by creatinine- vs. cystatin c-based formulae. Drugs Aging. 2017;34(6):445–52.PubMedCrossRefGoogle Scholar
  49. 49.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41.PubMedCrossRefGoogle Scholar
  50. 50.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461–70.PubMedCrossRefGoogle Scholar
  51. 51.
    Levey AS, Stevens LA. Estimating GFR using the ckd epidemiology collaboration (ckd-epi) creatinine equation: more accurate gfr estimates, lower ckd prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010;55(4):622–7.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Schaeffner ES, Ebert N, Delanaye P, Frei U, Gaedeke J, Jakob O, et al. Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med. 2012;157(7):471–81.PubMedCrossRefGoogle Scholar
  53. 53.
    Branten AJW, Vervoort G, Wetzels JFM. Serum creatinine is a poor marker of GFR in nephrotic syndrome. Nephrol Dial Transplant [Internet]. 2005 Apr 1 [cited 2018 Dec 9];20(4):707–11. Available from:
  54. 54.
    Corsonello A, Pedone C, Corica F, Mussi C, Carbonin P, Incalzi RA. Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Arch Intern Med. 2005;165(7):790–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Stevens LA, Nolin TD, Richardson MM, Feldman HI, Lewis JB, Rodby R, et al. Comparison of drug dosing recommendations based on measured gfr and kidney function estimating equations. Am J Kidney Dis. 2009;54(1):33–42. Available from: Accessed 13 Dec 2018.
  56. 56.
    CKD & Drug Dosing: Information for Providers | NIDDK. Available from: Accessed 13 Dec 2018.
  57. 57.
    Chronic Kidney Disease, Classification | National Kidney Foundation [Internet]. [cited 2018 Dec 13]. Available from:
  58. 58.
    Khan S, Loi V, Rosner MH. Drug-induced kidney injury in the elderly. Drugs Aging. 2017;34(10):729–41.PubMedCrossRefGoogle Scholar
  59. 59.
    Shlipak MG, Katz R, Kestenbaum B, Fried LF, Newman AB, Siscovick DS, et al. Rate of kidney function decline in older adults: a comparison using creatinine and cystatin C. Am J Nephrol. 2009;30(3):171–8.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J, et al. Diabetic kidney disease: a report from an ada consensus conference. Diabetes Care. 2014;37(10):2864–2883.Google Scholar
  61. 61.
    Rhee JJ, Ding VY, Rehkopf DH, Arce CM, Winkelmayer WC. Correlates of poor glycemic control among patients with diabetes initiating hemodialysis for end-stage renal disease. BMC Nephrol [Internet]. 2015 Dec 9 [cited 2018 Dec 10];16:204. Available from:
  62. 62.
    Bloomgarden Z, Handelsman Y. How does CKD affect HbA1c? J Diabetes. 2018;10(4):270–270. Available from: Accessed 10 Dec 2018.
  63. 63.
    Speeckaert M, Van Biesen W, Delanghe J, Slingerland R, Wiecek A, Heaf J, et al. Are there better alternatives than haemoglobin A1c to estimate glycaemic control in the chronic kidney disease population? Nephrol Dial Transplant. 2014;29(12):2167–77. Available from: Accessed 10 Dec 2018.
  64. 64.
    Bosi E. Metformin—the gold standard in type 2 diabetes: what does the evidence tell us? Diabetes Obes Metab. 2009;11(Suppl 2):3–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Kim KS, Kim SK, Sung KM, Cho YW, Park SW. Management of type 2 diabetes mellitus in older adults. Diabetes Metab J. 2012;36(5):336–44.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Schejter YD, Turvall E, Ackerman Z. Characteristics of patients with sulphonurea-induced hypoglycemia. J Am Med Dir Assoc. 2012;13(3):234–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Harper W, Clement M, Goldenberg R, Hanna A, Main A, Retnakaran R, et al. Canadian Diabetes Associaton Guidelines – Pharmacologic management of type 2 diabetes. 2013. Available from: Accessed 30 Jul 2016.
  68. 68.
    Clemens KK, McArthur E, Dixon SN, Fleet JL, Hramiak I, Garg AX. The hypoglycemic risk of glyburide (glibenclamide) compared with modified-release gliclazide. Can J Diabetes. 2015. Available from: Accessed 9 Jul 2015.
  69. 69.
    Balant L, Zahnd G, Gorgia A, Schwarz R, Fabre J. Pharmacokinetics of glipizide in man: Influence of renal insufficiency. Diabetologia. 1973;(Sept):331–8.Google Scholar
  70. 70.
    Arjona Ferreira JC, Marre M, Barzilai N, Guo H, Golm GT, Sisk CM, et al. Efficacy and safety of sitagliptin versus glipizide in patients with type 2 diabetes andmoderate-to-severe chronic renal insufficiency. Diabetes Care [Internet]. 2013;36(5):1067–73. Available from:,,
  71. 71.
    Schwartz A V. TZDs and bone: a review of the recent clinical evidence. PPAR Res. 2008:297893.Google Scholar
  72. 72.
    Meier C, Kraenzlin ME, Bodmer M, Jick SS, Jick H, Meier CR. Use of thiazolidinediones and fracture risk. Arch Intern Med. 2008;168(8):820–5.PubMedCrossRefGoogle Scholar
  73. 73.
    • Molitch ME. Diabetes management in the elderly patient with kidney disease. American Society of Nephrology Kidney News. 2015. Available from: Accessed 26 Sept 2018. This article provides an up to date review and recommendations for diabetes management in older adults with CKD.
  74. 74.
    Nattrass M, Lauritzen T. Review of prandial glucose regulation with repaglinide: a solution to the problem of hypoglycaemia in the treatment of type 2 diabetes? Int J Obes. 2000;24(Supple 3):S21–31.CrossRefGoogle Scholar
  75. 75.
    Abaterusso C, Lupo A, Ortalda V, De Biase V, Pani A, Muggeo M, et al. Treating elderly people with diabetes and stages 3 and 4 chronic kidney disease. Clin J Am Soc Nephrol. 2008;3(4):1185–94. Available from: Accessed 2 Apr 2015.
  76. 76.
    Schumacher S, Abbasi I, Weise D, Hatorp V, Sattler K, Sieber J, et al. Single- and multiple-dose pharmacokinetics of repaglinide in patients with type 2 diabetes and renal impairment. Eur J Clin Pharmacol. 2001;57(2):147–52. Available from: Accessed 26 Sept 2018.
  77. 77.
    Bourdel-Marchasson I, Schweizer A, Dejager S. Incretin therapies in the management of elderly patients with type 2 diabetes mellitus. Hospital Pract (1995). 2011;39(1):7–21.CrossRefGoogle Scholar
  78. 78.
    Puttanna A, Varadhan L. Renal safety of newer medications. Practical Diabetes. 2016;33(3):1.CrossRefGoogle Scholar
  79. 79.
    Engel SS, Williams-Herman DE, Golm GT, Clay RJ, Machotka SV, Kaufman KD, et al. Sitagliptin: review of preclinical and clinical data regarding incidence of pancreatitis. Int J Clin Pract. 2010;64(7):984–90.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Schweizer A, Dejager S, Bosi E. Comparison of vildagliptin and metformin monotherapy in elderly patients with type 2 diabetes: a 24-week, double-blind, randomized trial. Diabetes Obes Metab. 2009;11(8):804–12.PubMedCrossRefGoogle Scholar
  81. 81.
    Schweizer A, Dejager S, Foley JE, Shao Q, Kothny W. Clinical experience with vildagliptin in the management of type 2 diabetes in a patient population ≥75 years: a pooled analysis from a database of clinical trials. Diabetes Obes Metab. 2011;13(1):55–64. Available from: Accessed 26 Sept 2018.
  82. 82.
    Shankar RR, Xu L, Golm GT, O’neill EA, Goldstein BJ, Kaufman KD, et al. A comparison of glycaemic effects of sitagliptin and sulfonylureas in elderly patients with type 2 diabetes mellitus. Int J Clin Pract. 2015;69(6):626–312.PubMedCrossRefGoogle Scholar
  83. 83.
    Hahr AJ, Molitch ME. Management of diabetes mellitus in patients with chronic kidney disease. Clin Diabetes Endocrinol. 2015;1:2. Available from: Accessed 20 Aug 2018.
  84. 84.
    Clemens KK, McArthur E, Fleet JL, Hramiak I, Garg AX. The risk of pancreatitis with sitagliptin therapy in older adults: a population-based cohort study. CMAJ Open. 2015;2(2):E172–81.CrossRefGoogle Scholar
  85. 85.
    Yale J-F, Bakris G, Cariou B, Yue D, David-Neto E, Xi L, et al. Efficacy and safety of canagliflozin in subjects with type 2 diabetes and chronic kidney disease. Diabetes Obes Metab. 2013;15(5):463–73.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Kohan DE, Fioretto P, Tang W, List JF. Long-term study of patients with type 2 diabetes and moderate renal impairment shows that dapagliflozin reduces weight and blood pressure but does not improve glycemic control. Kidney Int. 2014;85(4):962–71.PubMedCrossRefGoogle Scholar
  87. 87.
    Mikhail N. Use of sodium-glucose cotransporter type 2 inhibitors in older adults with type 2 diabetes mellitus. South Med J. 2015;108(2):91–6.PubMedCrossRefGoogle Scholar
  88. 88.
    Bode B, Stenlof K, Sullivan D, Fung A, Usiskin K. Efficacy and safety of canagliflozin treatment in older subjects with type 2 diabetes mellitus: a randomized trial. Hosp Pract. 2013;41(2):72–84.CrossRefGoogle Scholar
  89. 89.
    Leiter LA, Cefalu WT, de Bruin TWA, Gause-Nilsson I, Sugg J, Parikh SJ. Dapagliflozin added to usual care in individuals with type 2 diabetes mellitus with preexisting cardiovascular disease: a 24-week, multicenter, randomized, double-blind, placebo-controlled study with a 28-week extension. J Am Geriatr Soc. 2014;62(7):1252–62.PubMedCrossRefGoogle Scholar
  90. 90.
    Yki-Järvinen H, Dressler A, Ziemen M. Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes. Diabetes Care. 2000;23(8):1130–6.PubMedCrossRefGoogle Scholar
  91. 91.
    American Diabetes Association. 11. Older adults: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S119–25.CrossRefGoogle Scholar
  92. 92.
    Meneilly, GS, Knip, A, Miller, D, Sherifali, D, Tessier, DZA. Diabetes in older people [Internet]. Diabetes Canada Guidelines. 2018 [cited 2018 Sep 17]. Available from:
  93. 93.
    International Diabetes Federation. Managing older people with type 2 diabetes global guideline. 2013. Available from: Accessed 27 Sept 2018.
  94. 94.
    Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults. Diabetes Care. 2012;35(12):2650–64.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    Sherifali D, Bai J-W, Kenny M, Warren R, Ali MU. Diabetes self-management programmes in older adults: a systematic review and meta-analysis. Diabet Med. 2015;32(11):1404–14.PubMedCrossRefGoogle Scholar
  96. 96.
    Williams, ME, Stanton R. Kidney disease in elderly diabetic patients. In: Geriatric Nephrology Curriculum. American Society of Nephrology; 2009. p 1–5. Available from: Accessed 15 Aug 2018.
  97. 97.
    Casagrande S, Cowie CC, Fradkin JE. Intensive glycemic control in younger and older U.S. adults with type 2 diabetes. J Diabetes Complicat. 2017;31(8):1299–304.PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Hambling CE, Seidu SI, Davies MJ, Khunti K. Older people with type 2 diabetes, including those with chronic kidney disease or dementia, are commonly overtreated with sulfonylurea or insulin therapies. Diabet Med. 2017;34(9):1219–27.PubMedCrossRefGoogle Scholar
  99. 99.
    Munshi MN, Segal AR, Suhl E, Ryan C, Sternthal A, Giusti J, et al. Assessment of barriers to improve diabetes management in older adults. Diabetes Care. 2013;36(3):543–9.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kristin K. Clemens
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  • Niamh O’Regan
    • 3
    • 5
    • 6
  • Jinnie J. Rhee
    • 7
  1. 1.Department of Medicine, Division of EndocrinologyWestern UniversityLondonCanada
  2. 2.Department of Epidemiology and BiostatisticsWestern UniversityLondonCanada
  3. 3.St. Joseph’s Health Care LondonLondonCanada
  4. 4.Institute for Clinical Evaluative SciencesOntarioCanada
  5. 5.Lawson Health Research InstituteLondonCanada
  6. 6.Department of Medicine, Division of Geriatric MedicineWestern UniversityLondonCanada
  7. 7.Department of Medicine, Division of NephrologyStanford University School of MedicineStanfordUSA

Personalised recommendations