Dr Medha Munshi is the Director of the Joslin Geriatric Diabetes Program and an Associate Professor of Medicine at the Harvard Medical School. She is a staff geriatrician at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA. Dr. Munshi is board certified in Internal Medicine, Geriatric Medicine, and Endocrinology and Metabolism.
Since joining the faculty about 15 years ago, Dr. Munshi has developed a unique Geriatric Diabetes Program at the Joslin Diabetes Center. This model of care is an interdisciplinary program, beyond the traditional diabetes programs, that considers clinical, functional and psychosocial barriers faced by older adults before formulating individualized treatment strategies. Her clinical research is focused on identifying barriers to diabetes management and developing novel strategies to improve care of older adults.
She has co-edited a book “Geriatric Diabetes” with Dr. Lewis Lipsitz. She has published extensively on this subject and have presented nationally and internationally on the topic of care of older adults with diabetes.
Areas of Expertise (2)
- American Board of Internal Medicine : Member
Media Appearances (5)
New Guidance on Diabetes Care in Elderly Residential Facilities
"New American Diabetes Association (ADA) guidelines addressing diabetes management in long-term care and skilled nursing facilities emphasize treatment simplification, avoidance of hypoglycemia, and the need to reassess therapeutic goals for patients who are nearing the end of life.”
Dr Medha Munshi is featured in this article for Medscape.
Healthy Aging: Dealing With Diabetes
U.S. News: Health online
Dr Munshi’s healthy tips for managing diabetes are featured in this article for U.S. News: Health.
Mental Health Disorders: Too Much Sugar Affects the Brain - Memory, Dementia & Depression
Latinos Health online
Dr Munshi is referenced in this article for Latinos Health.
This Is What Sugar Does To Your Brain
Huffpost Healthy Living online
Dr Munshi’s research is cited in this article for Huffpost Healthy Living.
Diabetes Advice for the Elderly: Relax
The New York Times online
Dr Medha Munshi, director of the geriatrics program at the Joslin Diabetes Center in Boston, offers advice to families looking after geriatric diabetes patients.
Featured Articles (5)
More than 25% of the U.S. population aged ≥65 years has diabetes (1), and the aging of the overall population is a significant driver of the diabetes epidemic. Although the burden of diabetes is often described in terms of its impact on working-age adults, diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of institutionalization (2). Older adults with diabetes are at substantial risk for both acute and chronic microvascular and cardiovascular complications of the disease.
Despite having the highest prevalence of diabetes of any age-group, older persons and/or those with multiple comorbidities have often been excluded from randomized controlled trials of treatments—and treatment targets—for diabetes and its associated conditions. Heterogeneity of health status of older adults (even within an age range) and the dearth of evidence from clinical trials present challenges to determining standard intervention strategies that fit all older adults. To address these issues, the American Diabetes Association (ADA) convened a Consensus Development Conference on Diabetes and Older Adults (defined as those aged ≥65 years) in February 2012. Following a series of scientific presentations by experts in the field, the writing group independently developed this consensus report to address the following questions:
1. What is the epidemiology and pathogenesis of diabetes in older adults?
2. What is the evidence for preventing and treating diabetes and its common comorbidities in older adults?
3. What current guidelines exist for treating diabetes in older adults?
4. What issues need to be considered in individualizing treatment recommendations for older adults?
5. What are consensus recommendations for treating older adults with or at risk for diabetes?
6. How can gaps in the evidence best be filled?
28 February 2011
Episodes of hypoglycemia are particularly dangerous in the older population. To reduce the risk of hypoglycemia, relaxation of the standard hemoglobin A1c (HbA1c) goals has been proposed for frail elderly patients. However, the risk of hypoglycemia in this population with higher HbA1c levels is unknown.
Patients 69 years or older with HbA1C values of 8% or greater were evaluated with blinded continuous glucose monitoring for 3 days.
Forty adults (mean [SD] age, 75  years; HbA1C value, 9.3% [1.3%]; diabetes duration, 22  years; 28 patients [70%] with type 2 diabetes mellitus; and 37 [93%] using insulin) were evaluated. Twenty-six patients (65%) experienced 1 or more episodes of hypoglycemia (glucose level
1 May 1998
Loss of sex steroids causes an increase in both the resorption and formation of bone, with the former exceeding the latter. Based on evidence that the increased bone resorption after estrogen loss is due to an increase in osteoclastogenesis, we hypothesized that estrogen loss also stimulates osteoblastogenesis. We report that the number of mesenchymal osteoblast progenitors in the murine bone marrow was increased two- to threefold between 2 and 8 wk after ovariectomy and returned to control levels by 16 wk. Circulating osteocalcin, as well as osteoclastogenesis and the rate of bone loss, followed a very similar temporal pattern. Inhibition of bone resorption by administration of the bisphosphonate alendronate led to a decrease of the absolute number of osteoblast progenitors; however, it did not influence the stimulating effect of ovariectomy on osteoblastogenesis or osteoclastogenesis. These observations indicate that the increased bone formation that follows loss of estrogen can be explained, at least in part, by an increase in osteoblastogenesis. Moreover, they strongly suggest that unlike normal bone remodeling, whereby osteoblast development is stimulated by factors released from the bone matrix during osteoclastic resorption, estrogen deficiency unleashes signals that can stimulate the differentiation of osteoblast progenitors in a fashion that is autonomous from the need created by bone resorption, and therefore, inappropriate.
To determine whether didanosine (DDI), one of the drugs commonly used to treat infection with human immunodeficiency virus (HIV), contributes to the development of diabetes and hyperosmolar nonketotic diabetic syndrome (HNKDS).
One female patient was treated with DDI for infection with HIV during pregnancy. Soon after starting DDI treatment, she developed diabetes, which progressed to HNKDS.
Although not reported in the literature, hyperglycemia following treatment with DDI has been noted in 82 patients and is usually associated with pancreatitis. DDI should be recognized as one of the drugs known to potentially cause diabetes and HNKDS. With the increasing use of DDI and other drugs that cause hyperglycemia, such as pentamidine and dapsone, blood glucose should be monitored frequently in the HIV-infected patients.
Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life.