Management of diabetes mellitus in older people with comorbidities

Abstract

Diabetes mellitus is a chronic disease of aging that affects more than 20% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management.

Diabetes-Multimorbidity Combinations and Disability Among Middle-aged and Older Adults

“…The complexity of caring for patients with diabetesmultimorbidity has been previously recognized 6,7 and attributed to several reasons. First, specific diabetes-multimorbidity combinations may affect patients' ability to perform selfmanagement activities, resulting in suboptimal diabetes control.…”

Evaluation of Counseling Practices and Patient’s Satisfaction Offered by Pharmacists for Diabetics Attending Outpatient Pharmacies in Al Ahsa

“…The presenting findings in which majority of the patients sampled were between the ages of 51 and above are similar to those of earlier reports by Selvin et al (16), who reported prevalence of diabetes to be among the elderly individuals. Other studies have also reported that diabetes and its complications increase with increasing age (17,18). Thus, age is a major risk factor for diseases inclusive of diabetes mellitus, and this factor can be affected by educational levels of the patients.…”

Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults

“…1–3 Selecting the optimal treatment regimen for older adults with type 2 diabetes requires special considerations. 4– 6 Older adults with diabetes often have multiple comorbid conditions that may present medication contraindications or interactions that limit the use of certain pharmacologic classes. 4–8 Functional and cognitive limitations become more common with aging which could limit the use of complex regimens.…”

“…4–8 Functional and cognitive limitations become more common with aging which could limit the use of complex regimens. 4–6,9 Further, preventing hypoglycemia is critical for older patients, and guidelines recommend avoiding medications with the highest hypoglycemia risk, particularly long-acting sulfonylureas and sliding-scale insulin. 4–6,10–12 …”

“…14,15 Practice guidelines for older adults provide little direction for clinicians choosing between older medications with greater hypoglycemia risk and newer medications with less established evidence. 4–6 …”