Diabetes in older people

Abstract

The management of diabetes in older people is often challenging and poorly researched. The prevalence of cognitive impairment, chronic kidney disease and other co-existing comorbidities increase with age and have a significant impact on glycaemic control targets and treatment options. This conference examined current clinical practice, highlighted differences in the management of diabetes in the older person and suggested potential areas of future research.

Over Effective Control of Glycemic Levels Could Cause Cognitive Decline in Diabetic Geriatric Population

“…Elderly people with diabetes are vulnerable to hypoglycemia with the development neuroglycopenic symptoms like confusion and disorientation. Hospital admissions due to severe hypoglycemia are 40% higher than those for hyperglycemia in geriatric patients [21,22]. Patients with dementia or cognitive impairment were significantly more susceptible to hospitalization as a result of hypoglycemia than the patients with normal cognitive function [6,23].…”

“…Hypoglycemia associated with diabetes treatments with secretagogues or insulin is more frequent and more severe in the elderly and has potentially serious consequences, such as falls, cognitive impairment, arrhythmias or cardiovascular events [24]. The elderly treated with insulin have a higher risk of cognitive impairment and dementia because they have a long disease evolution and have a suboptimal control of glycemic targets [21]. The results of our study show a link between the treatment with insulin and a higher rate of severe cognitive impairment compared to the treatment with oral antidiabetics where no association was found.…”

“…The objective treatment according to different guide experts should be directed to the symptoms relief, preventing long-term complications, and avoiding hypoglycemia. The functional status of each patient should be determined, with special emphasis on the presence of cognitive impairment or dementia, where HbA1c targets should be around 8.5% [21].…”

Characteristics of elderly diabetes patients: focus on clinical manifestation, pathogenic mechanism, and the role of traditional Chinese medicine

“…Multiple medications may have adverse effects ( Noale et al, 2016 ), so appropriate management of comorbidities should be included in the guidelines for elderly diabetes patients ( Caughey et al, 2010 ). The challenge of managing elderly diabetes patients is that it is highly heterogeneous ( Bennett, 2015 ), which requires personal assessment of treatment and care options ( Munshi et al, 2020 ), as well as comprehensive education of patients ( Tekin and Zimmerman, 2020 ).…”