Do Your Parents Have Diabetes? You Should Know That Sometimes, Less Is More

Older adults are not a uniform group. There is an active 80-year-old who still works and may need to be treated just like a younger adult. But there is also the 65-year-old who is beginning to experience physical or cognitive decline. This new clinical guidance is aimed at the second group.

What begins as a well-intentioned effort to maintain good glucose control can turn into a therapeutic burden that does more harm than good. Medications that lower blood sugar too aggressively may cause hypoglycemia, confusion, falls, functional deterioration, and even hospitalization. At an age when the body is more fragile, the mind is more sensitive, and memory is less reliable, any such disturbance can pose a serious risk.

This is why we are urging clinicians and families to look at things differently. Through a new framework called the 4S Pathway, they encourage stopping to ask questions that until now many have avoided. Are all these medications still necessary? Do certain medications have to be changed?  Are your parents coping well with their treatment? Are they forgetting doses, falling more often, or quietly struggling?

For years, HbA1c levels have guided treatment decisions, but in older adults, these readings often fail to reflect actual glucose values. Anemia and comorbid conditions can distort results. In addition, HbA1c represents an average over three months and does not show episodes of low blood sugar, which can be dangerous in older adults. It also does not show high blood sugar spikes that may cause harm in the long and short term.

For example, someone who started insulin or sulfonylurea at age 50 may still be taking the same medications at age 80, even though they now eat less, feel weaker, and face daily challenges. They may experience dangerous heights and lows, yet their HbA1c appears normal.

This is where technology becomes important. Continuous glucose monitoring, which tracks glucose levels in real time and without finger pricks, allows older adults to follow their blood sugar throughout the day and make informed choices. For example, did the meal they ate raise their glucose? Is there a downward trend at night? Does their medication need adjusting? CGM provides a sense of control, even with irregular routines, reduced appetite, or when living alone. Currently, the system is available for people with type 1 diabetes and for type 2 patients who use insulin. It has already been submitted to the National Health Basket Committee to expand access.

The new study presents four simple steps. The first is identifying warning signs such as falls, confusion, or decreased appetite. The second is holding an open conversation with the parents and family members. The third is redefining treatment goals because perfect control is not always appropriate. The fourth is realigning medications. Continuous glucose monitoring plays an important role in this process. Sometimes medications are stopped. Sometimes they are reduced. Sometimes they are replaced with safer alternatives. The goal is to adapt the treatment to the person’s life, not the other way around.

Children have an important part to play. Do not hesitate to ask the doctor whether the medications are still appropriate. Is it possible to switch to safer options? Is it possible to lower the dose? Many clinicians today welcome this conversation, but it begins with someone asking the question.

I encourage families to rethink diabetes care in old age. Good care for older adults is first and foremost care that fits what the parent truly needs today.