In older people, diabetes is a disabling disease due to the associated vascular complications, multiple comorbidities and the increased prevalence of geriatric syndromes. Because of the complexity of diabetes in old age a comprehensive assessment is important at initial diagnosis, with the aim of preventing loss of autonomy and preserving independence. Cognitive and physical dysfunction are common in older people with diabetes which may affect health outcomes and quality of life. Individual therapeutic targets should take into consideration functional status, life expectancy and patient preferences.