Background: There are many ‘diabetes’ guidelines but most do not provide specific recommendations about the care of older people with diabetes (OPWD).  We encountered several methodological challenges when developing guidelines for managing OPWD (the McKellar Guidelines).  Key issues were the limited clinical trial evidence to support recommendations and the low value placed on expert/consensus opinion. Aims: To: a) develop a guideline development framework that followed National Health and Medical Research (NHMRC) clinical guideline (CPG) development recommendations, b) engage key stakeholders, OPWD and health professionals, in the development process, and c) determine whether there is a role for consensus/expert opinion when making care recommendations.  Method: We followed the NHMRC CPG development recommendations: conducted a structured literature review, appointed an expert advisory group and subjected the draft guidelines to peer-review (formative evaluation).  We undertook summative evaluation in a range of aged care settings before the Guidelines were released into the public domain. Results: Most of literature was graded at level 3 or 4.  OPWD were often excluded from clinical studies.  When they were included, they were basically healthy and prescribed none or few medicines. Therefore, they are not representative of most OPWD.The formative and summative evaluations highlighted key care issues not identified in the literature review, which, combined with the advice from the Expert Advisory Group (consensus opinion), played a valuable role in establishing the content validity and clinical relevance of the final Guideline. Conclusion: The guideline framework combined several strategies with the NHMRC CPG recommendations and enabled methodological issues to be addressed.  It resulted in clinically relevant, usable guidelines for caring for OPWD that meet the needs of key stakeholders, primarily because they were engaged in the design and evaluation process. Combining consensus/expert opinion with clinical evidence engages key stakeholders and contributes valuable practical information not reported in clinical trials.