According to the most recent surveillance data, the preva- lence of diabetes among U.S. adults aged $65yearsvariesfrom22to33%,depend- ing on the diagnostic criteria used. Post- prandial hyperglycemia is a prominent characteristic of type 2 diabetes in older adults (3,4), contributing to observed dif- ferencesinprevalencedependingonwhich diagnostictestisused(5).UsingtheA1Cor
fasting plasma glucose (FPG) diagnostic criteria, as is currently done for national surveillance, one-third of older adults with diabetes are undiagnosed (1). Theepidemicoftype2diabetesisclearly linked to increasing rates of overweight and obesity in the U.S. population, but pro- jectionsbytheCentersforDiseaseControl and Prevention (CDC) suggest that even if diabetes incidence rates level off, the prevalence of diabetes will double in the next 20 years, in part due to the aging of thepopulation(6).Otherprojectionssug- gestthatthenumberofcasesofdiagnosed diabetes in those aged $65 years will in- crease by 4.5-fold (compared to 3-fold in the total population) between 2005 and 2050 (7). Theincidenceofdiabetesincreaseswith age until about age 65 years, after which bothincidenceandprevalenceseemtolevel off (www.cdc.gov/diabetes/statistics). As a result,olderadultswithdiabetesmayeither have incident disease (diagnosed after age 65years)orlong-standingdiabeteswithon- set in middle age or earlier. Demographic and clinical characteristics of these two groups differ in a number of ways, adding to the complexity of making generalized treatment recommendations for older pa- tients with diabetes. Older-age–onset dia- betes is more common in non-Hispanic whites and is characterized by lower mean A1C and lower likelihood of insulin use than is middle-age–onset diabetes. Although a history of retinopathy is signif- icantly more common in older adults with middle-age–onsetdiabetesthanthosewith older-age onset, there is, interestingly, no difference in prevalence of cardiovascular disease (CVD) or peripheral