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Diabetes affects almost one in four elderly patients and has an even higher prevalence in nursing facilities.Elders with diabetes not only have a greater disease burden from diabets and its complications, they also suffer from multiple there chronic medial conditions, psychosocial problems including dementia and depression, as well as functional decline.In addition geriatric syndromes are more prevalent in this population, and ability to manage their medical problems not only depends on individual abilities, but caregiver support as well.This presentation will highlight these complexities affecting diabetes management in the elderly, the need to individualize glucose goals, risk of hypoglycemia, and how these factors affect selection of pharmacological treatments.The problem with transition of care to hospitals, rehabilitation centers, and home will be discussed in terms of its effect on diabetes management, especially medication errors, alteration of treatment protocols, financial challenges, and caregiver, a well as institutional problems and knowledge deficits.