Exp Clin Endocrinol Diabetes 2025; 133(04): 168-176
DOI: 10.1055/a-2500-0428
German Diabetes Association: Clinical Practice Guidelines

Diabetes Mellitus at an Elderly Age

Andrej Zeyfang
1   Department of Internal Medicine, Geriatric Medicine and Diabetology, medius KLINIK OSTFILDERN-RUIT, Ostfildern, Germany
,
Jürgen Wernecke
2   Department of Geriatric Medicine, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
,
Anke Bahrmann
3   Department of Internal Medicine 3 – Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
› Author Affiliations
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Notice of update

The DDG clinical practice guidelines are updated regularly during the second half of the calendar year. Please ensure that you read and cite the respective current version.

UPDATES TO CONTENT AND DIFFERENT RECOMMENDATIONS COMPARED TO THE PREVIOUS YEAR’S VERSION

Change 1:

Shortening of the text

Change 2:

Modification of recommendations for the use of OAD (glutide and gliflozin)

Thanks to good medical care in Germany, many people with diabetes mellitus now live well into old age: Of the 340,000 adults with type 1 diabetes, more than 100,000 are over 70 years of age. Approximately 8 million people have type 2 diabetes and one-fourth of this group is over 75 years of age, and approximately 1 million over the age of 80 [8].

Nationwide, there are a total of about 630,000 people with diabetes mellitus in need of care. The statements in the clinical practice guidelines are mainly directed at the majority of elderly people with type 2 diabetes and can only reflect some of the special characteristics of elderly people with diabetes. Topics such as type 1 diabetes at an elderly age, end of life, interface management or ethics are covered in the complete S2k Guideline.

The geriatric patient is defined by multimorbidity and a higher age. Age-typical functional limitations and high vulnerability create a special need for action that goes beyond blood glucose control and the management of cardiovascular risk factors or diabetes-typical complications. For differentiated therapy planning, elderly patients should be divided into functional groups ([Tab. 1]).

Tab. 1 Classification into functional groups.

Patient group

Patient description

Functionally independent

Elderly people with diabetes mellitus and good functional status. Patients with low comorbidity, at best low cognitive impairment and good compensation possibilities

Functionally slightly dependent

Elderly people with diabetes mellitus and limited functional status. Patients with multimorbidity, functional and cognitive limitations and geriatric syndromes

Functionally highly dependent

Elderly people with diabetes mellitus and extremely limited functional status or terminally ill patients. Patients with multimorbidity, geriatric symptoms, pronounced functional and cognitive limitations and the presence of diseases with limited life prognosis, e. g. terminal heart, kidney or malignant diseases

End of life

People who are on their deathbed

A geriatric assessment should be conducted to determine resources and deficits (division into functional groups) (Practice tool 1, see Appendix).



Publication History

Article published online:
06 May 2025

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