**3.2. Management of diabetes**

The general goals of diabetes care in elderly diabetics are similar as in younger diabetic individuals and include control of hyperglycemia and related symptoms; prevention, assessment, and treatment of macrovascular and microvascular complications of diabetes; education for self-management; and maintenance or improvement of general health condition. However, goals are similar in older and younger persons, and the care in elderly diabetics is complicated as a result of their clinical and functional heterogeneity [61]. Hyperglycemia leads to dehydration and impairs vision and cognitive function, contributing to functional decrease and a higher risk of falls in elderly diabetics [64]. Most of the clinicians consider too strict glycemic control (HbA1c of 7%), when compared to poor control (HbA1c >9%), leads to increased risk of wide glucose excursions and hypoglycemia. Therefore, current guidelines recommend a target glycemic range of 7–8.5% in elderly diabetics after explaining their comorbidities.

residents to eat better, since specialized diabetic diets do not seem to be superior to standard diets in this population. Food plans without concentrated sweets or added sugar and liberal diabetic diet are not recommended anymore. Current diabetes nutritional suggestions are not

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European Society of Clinical nutrition and Metabolism recommends minimum daily intake of 1.0–1.2 g protein/kg and 20–30 kcal/kg of nonprotein energy for sick elderly patients. The target for nutritional support in malnourished elderly individuals should be a total daily energy intake of 30–40 kcal/kg and a daily protein intake of 1.2–1.5 g protein/kg, according to current geriatric guidelines; however, person-to-person variability for nutritional requirements and

Carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products should be preferred instead of other carbohydrate sources, particularly those that comprise added fats, sugars, or sodium for good health. Consuming LGI food instead of HGI food is

Higher protein intake is associated with higher bone mass density, decrease in bone loss, and increase in muscle mass and strength [67–70]. An epidemiologic study reported that higher protein intake decreased health problems in older women [71]. The ADA suggests normal protein intake (15–20% of daily energy) in patients with normal renal function. The data about the safety of high-protein intake are scanty. However, a recent study reported that high-protein diet (approximately 30% of daily energy) provided less glucose-lowering medications after 1 year in elderly type 2 diabetic patients [72]. Kidney Disease Outcomes Quality Initiative of the American National Kidney Foundation (KDOQI) guidelines recommend a daily protein intake of 0.8 g/kg in diabetic patients with chronic kidney disease (CKD); however, there is little evidence related to adults older than 75 years. The results of 5-year prospective cohort study showed that higher daily protein intake (about 1.1 g/kg/day) did not decrease kidney function [73]. Low-protein intake might be associated with a decrease in muscle mass in CKD patients. Therefore, daily energy intake of 30 kcal/kg should be recom-

A Mediterranean-style, MUFA-rich eating pattern could be recommended as an alternative to a lower fat, higher carbohydrate eating pattern to provide a good glycemic control and decrease the CVD risk factors in type 2 diabetics. The general public recommendation to eat fish (especially fatty fish) at minimum 2 times a week could be applied to diabetic individuals. Diabetic patients should follow nutritional recommendations similar to the general population

fulfilled by these diets which redundantly limit sucrose intake [34].

physiological and pathological status should be taken into consideration [66].

better for ensuring good glycemic control and decreasing HbA1c levels [32].

mended to keep a neutral nitrogen balance [74].

**3.4. Energy**

**3.5. Carbohydrate**

**3.6. Protein**

**3.7. Fat**
