Management of diabetes in older adults

Type 2 diabetes prevalence is high in older adults and is expected to rise in the next decades. Diabetes in the population of frail older adults is accompanied by functional disability, several comorbidities, and premature mortality. A comprehensive geriatric assessment, including functional, cognit...

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Bibliographic Details
Published in:Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2018-03, Vol.28 (3), p.206-218
Main Authors: Sesti, G., Antonelli Incalzi, R., Bonora, E., Consoli, A., Giaccari, A., Maggi, S., Paolisso, G., Purrello, F., Vendemiale, G., Ferrara, N.
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Aging - psychology
Antidiabetic drugs
Biomarkers - blood
Blood Glucose - drug effects
Blood Glucose - metabolism
Clinical Decision-Making
Cognition
Diabetes Mellitus, Type 2 - blood
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - psychology
Drug Interactions
Female
Geriatric Assessment
Humans
Hypoglycemia
Hypoglycemia - chemically induced
Hypoglycemic Agents - adverse effects
Hypoglycemic Agents - therapeutic use
Italy
Male
Mental Health
Nutritional Status
Older adults
Patient-Centered Care
Personalized medicine
Risk Factors
Treatment Outcome
Type 2 diabetes
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Summary:Type 2 diabetes prevalence is high in older adults and is expected to rise in the next decades. Diabetes in the population of frail older adults is accompanied by functional disability, several comorbidities, and premature mortality. A comprehensive geriatric assessment, including functional, cognitive, mental and social status, is advisable for identifying the glycemic targets and glucose-lowering therapies, focused on patient preferences, needs, and risks. The therapeutic options for older adults with diabetes are like those for the adult population. However, the pharmacological treatments must be carefully prescribed and monitored, taking into consideration the patient cognitive capacities, the potentially life-threatening drug–drug interactions, the cardiovascular risk, and with the main goal of avoiding hypoglycemia. Also, a careful nutritional evaluation with appropriate tools, as well as a balanced and periodically monitored physical activity, contribute to an effective tailored care plan, as needed by older adults with diabetes. This review evaluates the currently available hypoglycemic drugs and the current indications to the Italian diabetology community, specifically with regard to the treatment of adults aged 75 years or older with diabetes, including the unmet needs by the guidelines.
ISSN:0939-4753
1590-3729
DOI:10.1016/j.numecd.2017.11.007