[Treatment of older persons with diabetes]

The prevalence of diabetes increases with age. In Spain, almost a third of persons older than 75 years have diabetes, and 10% of cases are undiagnosed. The approach in this age group is influenced by the coexistence of comorbidities and geriatric syndromes, as well as by the polypharmacy found in these patients. All the clinical practice guidelines recommend that glycemic control be individually tailored according to such factors as disease duration, the presence of complications, functional status, life expectancy, and the patient's environment, among other elements. In general, the therapeutic approach in older persons does not differ from that recommended in the younger population: it should be multifactorial, considering lifestyle modifications and control of hyperglycemia and the remaining cardiovascular risk factors. The main limitation is hypoglycemia, which is the most common and severe factor in this age group. Therapeutic recommendations in elderly persons with diabetes are based on expert opinion, since these patients are usually excluded from clinical trials. Consequently, clinical judgment is required to optimize the treatment of diabetes, with an emphasis on interventions to prevent symptoms and improve quality of life. DPP-4 inhibitors can be used, due to their low risk of hypoglycemias and safety. Before any treatment is started, its risk/benefit ratio should be evaluated, along with the patient's functional and cognitive status.