Diabetes Mellitus denotes a group of common metabolic disorders that share the common phenotype of hyperglycemia. It is becoming one of the most widespread health issues in all age groups. People living with diabetes have a higher risk of morbidity and mortality than the general population. As per IDF (International Diabetes Federation), the prevalence of diabetes in adults aged 20–79 years was estimated to be 8.8% in 2015 and is predicted to rise to 10.4% in 2040. As per data by ICMR- INDIAB -17, Prevalence of diabetes is 11.4%, while that of prediabetes is 15.3%. Older adults with diabetes are at an increased risk of various complications, such as cognitive decline, dementia, urinary incontinence, osteoporosis, falls, fractures, disability, and medication side effects. These issues significantly impact the quality of life and can interfere with effective diabetes management. As a result, managing type 2 diabetes in elderly patients has become a growing concern.
The American Diabetes Association recommends an HbA1c target of
less than 7% for older adults who have good cognitive and functional abilities
and few chronic conditions, while an HbA1c target of less than 8% is advised
for those with multiple comorbidities or cognitive impairment.
Diabetes management and antihyperglycemic treatment should be
personalized based on the patient's comorbidities and the duration of their
diabetes. It is essential to prioritize medications that have a low risk of
causing hypoglycemia. Safe antihyperglycemic options for older patients with
type 2 diabetes include metformin (the first-line treatment), pioglitazone,
dipeptidyl peptidase-4 inhibitors, and glucagon-like peptide-1 receptor
agonists. Insulin secretagogues, such as sulfonylureas, should be used
cautiously due to the increased risk of hypoglycemia. If sulfonylureas are
used, short-acting versions like gliclazide or glinides like repaglinide are
preferred. When insulin therapy is necessary, careful attention must be given
to the risk of hypoglycemia, and tight glycemic control should not be the
primary goal.
Author
(s) Details
Rohit Raina
Department of General Medicine, AIIMS Bathinda, Punjab-151001, India.
Preeti Singh Dhoat
Department of General Medicine, AIIMS Bathinda, Punjab-151001, India.
Amandeep Kaur
Department of General Medicine, AIIMS Bathinda, Punjab-151001, India.
Satarupa Samal
Department of General Medicine, AIIMS Bathinda, Punjab-151001, India.
Please see the book here:- https://doi.org/10.9734/bpi/mono/978-93-49238-92-3/CH5
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