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Type 2 diabetes mellitus in elderly institutionalized patients
M Cano Megias1, P Guisado Vasco2
1Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
Revista Clinica Espanola
|April 8, 2014
Summary
This case study examines managing type 2 diabetes in a 93-year-old woman hospitalized for respiratory infection. It discusses adjusting her glibenclamide and metformin regimen during hospitalization and upon discharge.
Area of Science:
- Geriatrics
- Internal Medicine
- Endocrinology
Background:
- A 93-year-old female with a 15-year history of type 2 diabetes mellitus (T2DM) was admitted for acute respiratory infection.
- The patient resides in an assisted-living facility and has a history of pneumonia 6 months prior.
- Her baseline laboratory results showed an HbA1c of 7.8% and a creatinine clearance of 45ml/min.
Purpose of the Study:
- To determine the optimal management of T2DM in elderly patients during hospitalization.
- To evaluate necessary adjustments to oral hypoglycemic agents (glibenclamide and metformin) in the context of acute illness.
- To provide guidance on treatment modifications upon patient discharge.
Main Methods:
- A retrospective review of a single patient case.
- Analysis of current treatment regimen (glibenclamide 5mg daily, metformin 850mg BID).
- Consideration of patient's age, comorbidities, renal function, and acute condition.
Main Results:
- The case highlights the challenges in managing T2DM in the elderly, particularly with comorbidities and acute illness.
- Potential need for dose adjustment or temporary cessation of metformin due to renal function and risk of lactic acidosis.
- Glibenclamide dose may require adjustment due to risk of hypoglycemia in elderly patients.
Conclusions:
- Hospitalization necessitates a careful reassessment of T2DM medication regimens in elderly patients.
- Individualized treatment plans are crucial, considering renal function, risk of hypoglycemia, and acute illness severity.
- Discharge planning should include clear instructions on medication adjustments to ensure continued glycemic control and patient safety.
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