Diabetes in Older Adults

Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database

“…Older people are a growing population with T2DM that account for approximately 50% of all cases of diabetes in adults and have differential characteristics, requiring tailored management approaches 1, 5, 8. The present descriptive study assessed the clinical and characteristics, the degree of glycaemic control, the presence of chronic diabetes‐related complications and the use of pharmacological treatments in a population of 318,020 adults with T2DM treated in a real‐life clinical setting.…”

“…Moreover, glycaemic goals were more often achieved by patients in the older subgroups regardless the presence of a CVD, in accordance with the results from clinical trials and observational studies suggesting that a global control of cardiovascular risk factors in older patients provides a greater benefit regarding morbidity and mortality than an intensive glycaemic control 13, 14, 15, 16, 17. Antihypertensive treatment, for instance, has benefits even in very old patients 18, 19, 20, 21, and there are also compelling evidences of the benefit of statins and antiplatelet agents in older adults in secondary prevention of CVD, while its use in primary prevention is controversial, and individual characteristics and the risk of related adverse events should be taken into account 5, 7, 22, 23, 24, 25.…”

“…On the other hand, older people are more likely to present cardiovascular complications, have higher rates of comorbid conditions, mortality, and prevalence of geriatric syndromes (e.g. cognitive dysfunction, functional impairment, frailty, falls and fractures, polypharmacy, depression, vision and hear impairment, persistent pain, urinary incontinence) than older people without diabetes 5. Finally, some studies report that older adults have a worse glycaemic control than other age groups with diabetes 6, and have the highest rates of hyperglycaemic crises and also of hypoglycaemia episodes requiring emergency department visits 5.…”

“…Although recommendations in clinical guidelines may vary per country, decision‐making should not be in general based on the age of the patient but on a combination of factors including general health status and functional and cognitive ability, among others 4, 5, 7, 8. Thus, in elderly individuals with preserved cognitive and functional abilities and a good life expectancy, the recommendation is a glycated haemoglobin goal similar to that recommended for younger adults.…”

A Framework for Crafting Clinical Practice Guidelines that are Relevant to the Care and Management of People with Multimorbidity

“…52 Similarly, treatment goals for glycemia, blood pressure, and dyslipidemia in older adults with diabetes may vary based on the degree of comorbidity. 53 There should be an effort to highlight key CPG recommendations and to consider how the presence of multimorbidity or specific coexisting conditions impacts the priority of following a recommendation. Examples include identifying groups with specific coexisting conditions that are not likely to benefit or may be harmed from following a CPG recommendation, and those for whom trade-offs are uncertain.…”