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The elderly Type 2 diabetic patient: special considerations

J E Morley1

  • 1Geriatric Research, Education and Clinical Center, St Louis VAMC, Division of Geriatric Medicine, St Louis University Medical School, Missouri 63125, USA.

Diabetic Medicine : a Journal of the British Diabetic Association
|December 30, 1998
PubMed
Summary

Managing diabetes in older adults requires careful consideration of age-related changes. Key factors include insulin resistance, impaired secretion, and comorbidities, necessitating individualized treatment plans for optimal glycemic control.

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Area of Science:

  • Gerontology
  • Endocrinology
  • Internal Medicine

Background:

  • Diabetes mellitus is prevalent in older adults, with many undiagnosed cases.
  • Age-related factors like insulin resistance and impaired insulin secretion contribute to hyperglycemia.
  • Comorbidities such as depression and cognitive impairment complicate diabetes management in the elderly.

Purpose of the Study:

  • To review the unique challenges and considerations for managing diabetes mellitus in older individuals.
  • To highlight the importance of individualized treatment approaches for elderly diabetic patients.
  • To discuss the role of lifestyle modifications and pharmacological interventions in this demographic.

Main Methods:

  • Literature review focusing on age-related physiological changes and diabetes.

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  • Analysis of factors influencing hyperglycemia in older adults.
  • Examination of management strategies, including diet, exercise, and medication.

    • Main Results:

    • Older adults exhibit common insulin resistance and impaired secretion, impacting glycemic control.
    • Leptin and amylin levels are associated with insulin resistance and glucose regulation.
    • Non-glycemic factors like dehydration, falls, and pressure ulcers are significant concerns.
    • Metformin use is contraindicated in patients over 80 due to renal function decline.
    • Insulin therapy requires careful monitoring for hypoglycemia due to age-related risks.

    Conclusions:

    • Individualized management is crucial for older adults with diabetes, considering comorbidities and functional status.
    • Exercise, particularly balance and stability training, is vital.
    • Careful medication selection, avoiding metformin in the very elderly and monitoring insulin therapy, is essential.
    • Provider education and patient support are critical for successful glycemic control and improved outcomes in elderly diabetics.