Supplementation in older adults

Abstract

Diabetes mellitus (DM) in older adults presents a complex clinical challenge due to the frequent coexistence of frailty, multimorbidity, and risk of malnutrition. In this context, the use of nutritional supplements is a common practice: data from population studies such as NHANES show that between 54% and 59% of people with diabetes regularly consume at least one nutritional supplement.

However, the American Diabetes Association (ADA) 2026 Standards of Care indicate that there is no consistent evidence to support routine vitamin or mineral supplementation to improve metabolic outcomes in individuals without documented nutritional deficiencies. Therefore, the current recommendation prioritizes individualized medical nutrition therapy, based on healthy eating patterns, with an emphasis on nutrient-dense whole foods over the isolated administration of nutrients.

Within this framework, comprehensive nutritional assessment is essential to identify patients who could benefit from specific supplementation strategies. The most frequently observed deficiencies in older adults with diabetes include vitamin B12, vitamin D, magnesium, iron, and calcium. Their detection is especially relevant due to their potential impact on neurological function, musculoskeletal health, functional capacity, and quality of life, particularly in patients with frailty, multimorbidity, and/or polypharmacy.

Nutritional supplementation in older adults with diabetes should be considered an individualized strategy aimed at correcting specific deficiencies and optimizing functionality, rather than a routine intervention for metabolic control.