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Diabetes in the elderly

G S Meneilly1, D Tessier

  • 1Department of Medicine, University of British Columbia, Vancouver, Canada.

Diabetic Medicine : a Journal of the British Diabetic Association
|November 1, 1995
PubMed
Summary
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Managing diabetes in older adults requires special attention due to insulin deficiency and increased hypoglycemia risk. Effective blood glucose control, a team approach, and preferred monitoring methods like capillary glucose are key for preventing long-term complications.

Area of Science:

  • Gerontology
  • Endocrinology
  • Public Health

Background:

  • Diabetes prevalence is high in individuals over 65, with many undiagnosed.
  • Elderly-onset diabetes differs from middle-aged diabetes, primarily involving insulin deficiency.
  • Older adults face a higher risk of diabetes complications, especially hypoglycemia.

Purpose of the Study:

  • To review the unique aspects of diabetes management in the elderly.
  • To highlight the increased susceptibility to hypoglycemia in older patients.
  • To discuss optimal strategies for blood glucose control and monitoring in the aged population.

Main Methods:

  • Review of epidemiological evidence and clinical considerations for elderly diabetes.
  • Analysis of factors contributing to hypoglycemia in the aged.

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  • Evaluation of monitoring techniques and pharmacological choices.

    • Main Results:

    • Elderly diabetes is mainly characterized by insulin deficiency, unlike in middle-aged individuals.
    • Older adults have diminished awareness of hypoglycemia and altered counterregulatory hormone responses.
    • Gliclazide is suggested as a preferred sulfonylurea due to lower hypoglycemia rates.

    Conclusions:

    • Adequate blood glucose control is crucial for reducing long-term diabetes complications in the elderly.
    • A multidisciplinary team approach is recommended for managing diabetes in older adults.
    • Capillary glucose monitoring and fructosamine may be more reliable than urine testing and HbA1C for monitoring.