The passage of time with advancing years brings an increasing risk of the development of diabetes, along with special considerations that are more appropriate for the older person, not necessarily fully concordant with the present generic policy of uniform treatment of diabetes whatever the age of person or the circumstances. Although the increase of diabetes is predominantly type 2 in nature, new onset of type 1 diabetes can present at any age including the later decades of life. Improved knowledge and modern therapies for diabetes have also meant that very many people with long-standing diabetes can expect to enjoy a greater length of life expectancy.1 Longevity itself must not be seen as the sole target of therapy, and for most, if not all, the quality of older years is equally important. Getting the balance right is highly desirable, although not always easily determined. To that end, providing best guidance to older people with diabetes requires a common sense approach with an emphasis on empathetic and holistic care. The benefits of good glycaemic control remain beyond argument. Hyperglycaemia in elderly people can be associated with a number of distressing consequences: increased susceptibility to infection, mobility difficulties, and sleep disturbance as well as mood and memory impairment. People feel better with well-controlled, stable glucose levels, and the evidence base is clear that good glycaemic control does lessen long-term complications of a microvascular nature but, as reported in the latest two large, published trials,2, 3 a beneficial effect in terms of cardiovascular protection has not been identified. Reducing macrovascular risk may relate more to addressing other aspects such as hypertension4 and the spectrum of circulatory risk factors, resulting in composite therapies,5 thereby predisposing to potential problems of polypharmacy which can be a real issue for elderly people. Intensified treatment, with increased risk of drug side effect, hypoglycaemia, postural hypotension and possibly even unexpected mortality,2 carries a personal price to the individual concerned. It should be self-evident that very tight diabetes control and other intensified management should not be targeted at the expense of quality of life without engaging that person on the issues concerned and without ensuring that the person's wishes are fully respected. Applying the principle of how one would wish to be treated oneself can be a very useful guide. Personalised advice on management, taking into account individual risk and informed patient wishes, should enable that right balance to be achieved. Recognising that managing diabetes in older years (old, elderly, aged— appropriate terms vary) has these special needs, the recent launch of a new, innovative national Institute of Diabetes for Older People (IDOP) is very welcome. Under the auspices of the Bedfordshire & Hertfordshire Postgraduate Medical School, IDOP6 has been established as an academic and research institution dedicated to enhancing the health and well-being of all older people with diabetes, through new initiatives in clinical practice, audit and research. Driving an ambitious agenda across a wide spectrum of activities, IDOP aspires to provide a forum for scientific interchange between health professionals and scientists and to involve people with diabetes and their families in educational programmes developed to directly promote their health and well-being. IDOP wishes to establish academic links and partnerships with other professional organisations involved in diabetes care to highlight the special needs of older people with diabetes and to ensure that policies and strategies are developed to meet that need. The Institute of Diabetes for Older People derives from the vision and considerable commitment to elderly people of Professor Alan Sinclair, who serves as the Institute's Director, well supported by a strong and experienced multidisciplinary advisory board. The recent (23 May 2008) launch of IDOP was incorporated into Professor Sinclair's inaugural lecture, ‘Surviving a Sweet Old Age!’, on taking up his appointment as Deputy Dean of the Postgraduate Medical School. His considerable academic contribution to diabetes in elderly people has been sustained over many years with a number of seminal research and clinical publications,7-9 all directed to improving patient care. Professor Sinclair was a cofounder of the British Geriatrics Society Special Interest Group in Diabetes (1992), Chairman of the European Clinical Guidelines Diabetes Working Group for Older People (2004) and, may we add, also a much valued past member of the Practical Diabetes International Editorial Advisory Board. IDOP is the first institute of its kind to promote good clinical practice, education and research in geriatric diabetes, and its objectives are very relevant to present day diabetes care. With more people now living over 60 years than under 16 years of age in the UK population, it is evident that the aspirations behind IDOP should be supported and, indeed, prioritised. IDOP merits success.