These include difficulty in preparing food and eating, alteration in the senses, renal and hepatic dysfunction, other coexisting diseases, neuropsychiatric problems, social isolation and poverty, and drugs and alcohol. Diet and exercise remain the cornerstones of therapy with type 2 diabetes mellitus. In obese elderly patients, weight loss should be the initial treatment. However, many older diabetic patients are not obese and should not be subjected to unnecessary calorie restriction. One may also consider micronutrient supplementation if the patient is not well nourished.
Exercise is beneficial for the older patient with diabetes.
For many sedentary older adults, any physical activity is an improvement. An emphasis should be placed on improving flexibility, strength, coordination and balance. Physically active elderly diabetic patients should undergo an exercise treadmill test prior to embarking on a moderate exercise program. If diet and exercise do not achieve the goal for glycemic control, oral agent therapy can be initiated. As our understanding of the pathogenesis of diabetes mellitus has increased, so have the therapeutic modalities.