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DIAGNOSIS OF DM IN THE ELDERLY:
 The current ADA guidelines for the diagnosis of DM, do not adjust glycemic criteria for age. This decision was based on the evidence that even mild hyperglycemia is associated with poor health outcomes as reported in younger individuals. 
The current ADA guidelines for the diagnosis of DM, do not adjust glycemic criteria for age. This decision was based on the evidence that even mild hyperglycemia is associated with poor health outcomes as reported in younger individuals. Although IGT may be associated with an increased risk of cardiovascular disease, it does not predispose to chronic diabetic microvascular complications.
As post-challenge glucose levels in particular rise with increasing age, GTT is not indicated for diagnosis. The best screening test for DM in older adults is determination of fasting plasma glucose levels.
Routine urine sugar testing for screening diabetes mellitus is inaccurate and is not recommended. Further, benign prostatic hyperplasia and diabetic autonomic bladder dysfunction are commonly found in elderly males and it alters the glucose content of urine due to the residual urine present in the bladder. In such patients, if at all urine sugar testing has to be done, the ‘double-voiding technique' should be used. The patient should be asked to discard one sample and the next sample collected after half-hour should be used to assess urine sugar.
Because a substantial number of elderly patients have undiagnosed diabetes, and these patients appear to have an increased incidence of macrovascular events, the current criteria recommend that a fasting glucose value be performed every 3 years in elderly patients at low risk for diabetes and yearly in patients at high risk, such as those with obesity, hypertension, family history, or the presence of complications commonly associated with diabetes.
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