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Managing diabetes care in the elderly population is challenging because of complex co-morbid medical issues and the generally lower functional status of older patients. Diabetes is an independent risk factor for admission into a care home and the prevalence of diabetes in this setting is high. A number of key issues relating to functional ability provide the basis of difficult management scenarios, e.g. falls, cognitive dysfunction, depressive illness, and a high prevalence of cardiovascular disease. This article presents a patient profile to illustrate the issues that are specific to the care of older people with diabetes and highlights the importance of clinical guidelines produced by the European Diabetes Working Party for Older People. These have been designed to give guidance for best clinical practice across all care settings. Copyright © 2007 John Wiley & Sons.