Initiate Research, Opportunities, and Networks for Underrepresented Early Career Investigators (IRON).

In the US, more than 1 in 4 older adults (≥65 years) have diabetes and the number of adults living with type 2 diabetes (T2D) is expected to increase rapidly in the coming decades. This is driven, in large part, by the overall aging of the US population. This shift presents a host of unique challenges as T2D in older adults is associated with increased prevalence of T2D-related complications and increased risk of adverse drug events, depression, functional decline, cognitive impairment, and mortality. Of particular concern in older adults is the increased risk of hypoglycemia. Rates of hypoglycemia are highest older adults, with recent data reporting that hypoglycemia events occur in up to 2/3 of older adults with diabetes and that with recurrent events an increased fear of hypoglycemia may develop which has negative implications for quality of life and psychological well-being and an impaired awareness of hypoglycemia may also develop which has important implications for physical well-being. In recognition of the unique challenges faced by older adults with diabetes, the American Diabetes Association’s (ADA) Standards of Care recommend that T2D management in older adults should be individualized and periodically revisited to ensure responsiveness to changes in functional and cognitive abilities, life expectancy, and comorbid conditions. Diabetes self-management education and support (DSMES) is an integral part of diabetes management. It is associated with a range of improvements in T2D-related outcomes, including improved glycemic control, reductions in rates of hypo- and hyperglycemia, and improved quality of life. Despite the clear benefits of DSMES, the increasing prevalence of older adults with T2D, and the unique challenges faced by older adults (e.g., geriatric syndromes), it is unclear if standard DSMES addresses necessary self-care considerations for older adults. To account for the nuances of aging while managing T2D, the Association of Diabetes Care and Education Specialist (ADCES) developed well-defined aging components that correspond with each of the standard DSMES modules. These considerations are meant to provide guidance and support that is consistent with the ADA’s recommendations for care of older adults. However, to our knowledge, there are no studies examining the effectiveness of administering DSMES with age-related considerations among older adults living with T2D. Moreover, it is not clear if older adults who receive DSMES are provided with the education components that address the nuances of aging. This is particularly of interest due to the challenges of managing T2D and the disproportionate risk of adverse clinical outcomes (e.g., hypoglycemia) in older adults.