New challenges face the diabetologist from the enlarging elderly population with its increased prevalence of diabetes mellitus. Health-care utilization increases with both age and diabetes mellitus. The ways in which the elderly enter and respond to the healthcare system have changed significantly. Aging exerts a variable and recognizable influence on the way illnesses develop and how patients perceive their symptoms. The most important interaction of aging and disease is increased vulnerability to the development of severe diabetic complications. The techniques of history and physical examination are modified with age. An overall assessment of function becomes an important technique that assists in both diagnosis and management of elderly patients. Several important geriatric syndromes including delirium, urinary incontinence, falls, systolic hypertension, and polypharmacy are particularly common in elderly diabetic patients. Approaches to these prevalent conditions in the elderly are discussed. Diabetes Care 13 (Suppl. 2):34-46, 1990 T he age-related increase in prevalence of clinical diabetes and the rapid growth in the elderly population offer new challenges to the diabetologist. Health-care delivery needs, disease complexity, and symptoms of illness change with advancing age. Awareness of the principle features of geriatric medicine From the Division on Aging,