353 ISSN 1758-1907 10.2217/DMT.13.39 © 2013 Future Medicine Ltd Diabetes Manage. (2013) 3(5), 353–355 The presence of comorbid conditions in older patients with diabetes adds considerable complexity to therapeutic management and care [1,2], and may affect functional capabilities and health outcomes [3,4]. More than 50% of older diabetic patients will have at least three comorbid conditions [1,2], with as many as 60% facing treatment conflict as a result [2]. Treatment conflicts are difficult to manage as there is often no or limited evidence-based information to help guide clinicians. The existence of chronic obstructive pulmonary disorder (COPD) in those with diabetes represents one of these conflicts and presents a therapeutic dilemma for clinicians treating those patients. There are no randomized trials that have assessed both the outcomes of diabetes complications and reduction in COPD exacerbations in older patients with both conditions. COPD is a common comorbidity in the older diabetic population, with a reported prevalence of between 10 and 20% [1,2]. Furthermore, of the chronic conditions, COPD and diabetes are both projected to be among the top ten leading causes of mortality and burden of disease worldwide by 2030 [5]. COPD is a progressive lung condition, characterized by a largely irreversible airflow obstruction resulting in a cough and dyspnea, along with acute exacerbations of these symptoms that often require hospitalization [6]. The presence of COPD in patients with diabetes is associated with the reduced ability to perform selfmanagement activities necessary for optimal diabetes control and associated therapeutic challenges [7]. Corticosteroids are one of the recommended therapies for COPD from international guidelines [8,9], which poses a therapeutic dilemma for clinicians who care for patients with diabetes and COPD. When considering diabetes guidelines [101], corticosteroids are not recommended in patients with diabetes due to the potential for hyperglycemia, subsequent poorer diabetes control and an increased risk of disease progression [10,11,101]. However, optimal treatment of COPD with corticosteroids in accord with current COPD guideline treatment recommendations is likely to place the patient with comorbid diabetes at increased risk of diabetes complications and poorer long-term health outcomes. While the treatment and prevention of COPD exacerbations is a priority, this needs to be balanced with managing long-term diabetes outcomes.