Are high blood sugar levels in the elderly ignored?

In a survey of 530 patients, aged 75 years and older, who were admitted to a general teaching hospital in Christchurch, 60 (11.3%) were known diabetics. One hundred and seventy-six other patients (33.2%) had a last measured laboratory blood glucose level of greater than 7.8 mmol/l, of whom 27 people (5.1% of all patients) had significant hyperglycemia (over 11 mmol/l). The Geriatric Assessment and Rehabilitation Unit (ARU) and acute general medical wards of the Princess Margaret Hospital made little use of the specialised Diabetes Services for help in managing known or newly diagnosed diabetics. The mean in-hospital laboratory blood glucose value for all diabetics was an unphysiological value of 12.2 mmol/l, compared with a community mean of 4.9 mmol/l and hyperglycemia persisted after resolution of acute medical problems. ARU diabetic patients had significantly lower blood glucose values than those achieved by physicians in acute medical wards. Prescribed medications such as steroids or diuretics contributing to insulin resistance were rarely modified. It is concluded that 16.4% of elderly patients had significant hyperglycemia or poorly managed diabetes mellitus, and that both general and geriatric physicians underestimated both the severity and consequences of elevated blood sugars in older patients in a regional New Zealand community with a 'high' diabetes profile.