Type 2 diabetes mellitus in older adults: clinical considerations and management

Srikanth Bellary*, Ioannis Kyrou, James E. Brown, Clifford J. Bailey

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.

Original languageEnglish
Pages (from-to)534-548
Number of pages15
JournalNature Reviews Endocrinology
Issue number9
Early online date25 Jun 2021
Publication statusPublished - Sept 2021

Bibliographical note

Funding: S.B. has received research grants from The Binding Site Ltd. and Novo Nordisk, UK, Ltd. as well as speaker fees and honoraria from AstraZeneca, Boehringer Ingelheim, MSD, Novo Nordisk, Janssen, Eli Lilly, and Sanofi-Aventis outside of the submitted work. C.J.B. has received personal fees from AstraZeneca, Boehringer Ingelheim, Elcelyx, Lexicon, Poxel, Eli Lilly, Janssen, Merck, Sharpe & Dohme, Novo Nordisk, and Sanofi-Aventis. J.E.B. has received speaker fees from Gilead Biosciences Inc. I.K. has no competing interests to declare.


  • Endocrine system
  • metabolic diseases
  • Type 2 diabetes


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