J Korean Diabetes.  2015 Jun;16(2):89-100. 10.4093/jkd.2015.16.2.89.

New Guidelines for Elderly Diabetic Patients

• Lee J

• KMID: 2137266
• DOI: http://doi.org/10.4093/jkd.2015.16.2.89

Abstract

The proportion of the population aged 65 years and older has increased, and at least 20% of people in that age group have diabetes. This percentage is expected to increase rapidly in the future. Elderly people with diabetes have a higher incidence of heart disease and cerebrovascular disease, resulting in decreased quality of life and increased mortality and morbidity. It is important to manage diabetes in the elderly when it is concomitant with geriatric syndromes, such as depression, polypharmacy, cognitive dysfunction, urinary incontinence, and falling. Before determining target blood glucose levels and drug regimens, the co-morbidities, complications, and individual circumstances of each patient should be assessed. Before determining target blood glucose levels and drug regimens, the co-morbidities, complications, and individual circumstances of each patient should be assessed. In conjunction with the control of classical cardiovascular risk factors, such as blood pressure and dyslipidemia, these assessments can reduce the morbidity and mortality of diabetes further. Many clinical studies on blood glucose control are required and the results will be helpful in the management of elderly diabetic patients.

Keyword

Cardiovascular diseases; Diabetes mellitus; Geriatrics

MeSH Terms

Aged*
Blood Glucose
Blood Pressure
Cardiovascular Diseases
Depression
Diabetes Mellitus
Dyslipidemias
Geriatrics
Heart Diseases
Humans
Incidence
Mortality
Polypharmacy
Quality of Life
Risk Factors
Urinary Incontinence
Blood Glucose

Reference

References

1. Statistics Korea. 2014 Social Indicators in Korea. Available from:. http://kostat.go.kr/portal/korea/kor_nw/2/6/1/index.board?bmode=read&aSeq=334501. (updated 2015 Mar 19).

2. Korean Diabetes Association. Diabetes Fact Sheet. Seoul: Korean Diabetes Association;2013.

3. American Diabetes Association. Position statement: Older adults. Diabetes Care. 2015; 38:S67–9.

4. American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus. Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update. J Am Geriatr Soc. 2013; 61:2020–6.

5. Laiteerapong N, Karter AJ, Liu JY, Moffet HH, Sudore R, Schillinger D, John PM, Huang ES. Correlates of quality of life in older adults with diabetes: the diabetes & aging study. Diabetes Care. 2011; 34:1749–53.

6. Kimbro LB, Mangione CM, Steers WN, Duru OK, McEwen L, Karter A, Ettner SL. Depression and all-cause mortality in persons with diabetes mellitus: are older adults at higher risk? Results from the Translating Research Into Action for Diabetes Study. J Am Geriatr Soc. 2014; 62:1017–22.

7. Black SA, Markides KS. Depressive symptoms and mortality in older Mexican Americans. Ann Epidemiol. 1999; 9:45–52.

8. Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract. 2005; 17:123–32.

9. Huang ES, Karter AJ, Danielson KK, Warton EM, Ahmed AT. The association between the number of prescription medications and incident falls in a multiethnic population of adult type-2 diabetes patients: the diabetes and aging study. J Gen Intern Med. 2010; 25:141–6.

10. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, Huang ES, Korytkowski MT, Munshi MN, Odegard PS, Pratley RE, Swift CS. Diabetes in older adults. Diabetes Care. 2012; 35:2650–64.

11. Lu FP, Lin KP, Kuo HK. Diabetes and the risk of multisystem aging phenotypes: a systematic review and metaanalysis. PLoS One. 2009; 4:e4144.

12. Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. 2006; 5:64–74.

13. Abbatecola AM, Paolisso G, Corsonello A, Bustacchini S, Lattanzio F. Antidiabetic oral treatment in older people: does frailty matter? Drugs Aging. 2009; 26(Suppl 1):53–62.

14. Punthakee Z, Miller ME, Launer LJ, Williamson JD, Lazar RM, Cukierman-Yaffee T, Seaquist ER, IsmailBeigi F, Sullivan MD, Lovato LC, Bergenstal RM, Gerstein HC. ACCORD Group of Investigators; ACCORD-MIND Investigators. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Diabetes Care. 2012; 35:787–93.

15. Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009; 301:1565–72.

16. Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, Burt V, Curtin L, Engelgau M, Geiss L. 1999–2000 national health and nutrition examination survey. Prevalence of lower-extremity disease in the US adult population >=40 years of age with and without diabetes: 1999–2000 national health and nutrition examination survey. Diabetes Care. 2004; 27:1591–7.

17. Volpato S, Blaum C, Resnick H, Ferrucci L, Fried LP, Guralnik JM. Women's Health and Aging Study. Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The Women's Health and Aging Study. Diabetes Care. 2002; 25:678–83.

18. Brown JS, Vittinghoff E, Wyman JF, Stone KL, Nevitt MC, Ensrud KE, Grady D. Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc. 2000; 48:721–5.

19. Dugan E, Cohen SJ, Bland DR, Preisser JS, Davis CC, Suggs PK, McGann P. The association of depressive symptoms and urinary incontinence among older adults. J Am Geriatr Soc. 2000; 48:413–6.

20. Chang JT, Ganz DA. Quality indicators for falls and mobility problems in vulnerable elders. J Am Geriatr Soc. 2007; 55(Suppl 2):S327–34.

21. Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. Am J Prev Med. 2008; 35:357–63.

22. Miller CK, Edwards L, Kissling G, Sanville L. Nutrition education improves metabolic outcomes among older adults with diabetes mellitus: results from a randomized controlled trial. Prev Med. 2002; 34:252–9.

23. Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, Tylavsky FA, Newman AB. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes. 2006; 55:1813–8.

24. Villareal DT, Chode S, Parimi N, Sinacore DR, Hilton T, Armamento-Villareal R, Napoli N, Qualls C, Shah K. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011; 364:1218–29.

25. Christmas C, Andersen RA. Exercise and older patients: guidelines for the clinician. J Am Geriatr Soc. 2000; 48:318–24.

26. Miller SL, Wolfe RR. The danger of weight loss in the elderly. J Nutr Health Aging. 2008; 12:487–91.

27. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008; 359:1577–89.

28. Miller ME, Bonds DE, Gerstein HC, Seaquist ER, Bergenstal RM, Calles-Escandon J, Childress RD, Craven TE, Cuddihy RM, Dailey G, Feinglos MN, IsmailBeigi F, Largay JF, O'Connor PJ, Paul T, Savage PJ, Schubart UK, Sood A, Genuth S. ACCORD Investigators. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ. 2010; 340:b5444.

29. ADVANCE Collaborative Group. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G, Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B, Bompoint S, de Galan BE, Joshi R, Travert F. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358:2560–72.

30. Duckworth WC, Abraira C, Moritz TE, Davis SN, Emanuele N, Goldman S, Hayward R, Huang GD, Marks JB, Reaven PD, Reda DJ, Warren SR, Zieve FJ. Investigators of the VADT. The duration of diabetes affects the response to intensive glucose control in type 2 subjects: the VA Diabetes Trial. J Diabetes Complications. 2011; 25:355–61.

31. Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, Howard BV, Kirkman MS, Kosiborod M, Reaven P, Sherwin RS. American Diabetes Association; American College of Cardiology Foundation; American Heart Association. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care. 2009; 32:187–92.

32. Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, Zagar T, Poole CD. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet. 2010; 375:481–9.

33. Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes Care. 2011; 34:1329–36.

34. Laiteerapong N, Iveniuk J, John PM, Laumann EO, Huang ES. Classification of older adults who have diabetes by comorbid conditions, United States, 2005–2006. Prev Chronic Dis. 2012; 9:E100.

35. Fravel MA, McDanel DL, Ross MB, Moores KG, Starry MJ. Special considerations for treatment of type 2 diabetes mellitus in the elderly. Am J Health Syst Pharm. 2011; 68:500–9.

36. Lipska KJ, Bailey CJ, Inzucchi SE. Use of metformin in the setting of mild-to-moderate renal insufficiency. Diabetes Care. 2011; 34:1431–7.

37. Hasan FM, Alsahli M, Gerich JE. SGLT2 inhibitors in the treatment of type 2 diabetes. Diabetes Res Clin Pract. 2014; 104:297–322.

38. Sehgal V, Bajwa SJ, Sehgal R, Consalvo JA. Management of diabetes in the elderly with canagliflozin: a newer hypoglycemic drug on the horizon. J Pharmacol Pharmacother. 2014; 5:227–31.

39. Herman WH, Ilag LL, Johnson SL, Martin CL, Sinding J, Al Harthi A, Plunkett CD, LaPorte FB, Burke R, Brown MB, Halter JB, Raskin P. A clinical trial of continuous subcutaneous insulin infusion versus multiple daily injections in older adults with type 2 diabetes. Diabetes Care. 2005; 28:1568–73.

40. Lee P, Chang A, Blaum C, Vlajnic A, Gao L, Halter J. Comparison of safety and efficacy of insulin glargine and neutral protamine hagedorn insulin in older adults with type 2 diabetes mellitus: results from a pooled analysis. J Am Geriatr Soc. 2012; 60:51–9.

41. Riddle MC. Glycemic management of type 2 diabetes: an emerging strategy with oral agents, insulins, and combinations. Endocrinol Metab Clin North Am. 2005; 34:77–98.

42. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Erdine S, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Lindholm LH, Viigimaa M, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Waeber B, Williams B. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007; 25:1105–87.

43. Cooper-DeHoff RM, Gong Y, Handberg EM, Bavry AA, Denardo SJ, Bakris GL, Pepine CJ. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA. 2010; 304:61–8.

44. Sleight P, Redon J, Verdecchia P, Mancia G, Gao P, Fagard R, Schumacher H, Weber M, Böhm M, Williams B, Pogue J, Koon T, Yusuf S. ONTARGET investigators. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens. 2009; 27:1360–9.

45. Moreno G, Mangione CM. Management of cardiovascular disease risk factors in older adults with type 2 diabetes mellitus: 2002–2012 literature review. J Am Geriatr Soc. 2013; 61:2027–37.

46. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R. Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective metaanalysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005; 366:1267–78.

47. ACCORD Study Group. Ginsberg HN, Elam MB, Lovato LC, Crouse JR 3rd, Leiter LA, Linz P, Friedewald WT, Buse JB, Gerstein HC, Probstfield J, Grimm RH, IsmailBeigi F, Bigger JT, Goff DC Jr, Cushman WC, Simons-Morton DG, Byington RP. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1563–74.

48. Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR, Forder P, Pillai A, Davis T, Glasziou P, Drury P, Kesäniemi YA, Sullivan D, Hunt D, Colman P, d'Emden M, Whiting M, Ehnholm C, Laakso M. FIELD study investigators. Effects of longterm fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005; 366:1849–61.

49. Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, Faas FH, Linares E, Schaefer EJ, Schectman G, Wilt TJ, Wittes J. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med. 1999; 341:410–8.

50. Ogawa H, Nakayama M, Morimoto T, Uemura S, Kanauchi M, Doi N, Jinnouchi H, Sugiyama S, Saito Y. Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008; 300:2134–41.