Diabetes in the Elderly Population

Diabetes Mellitus is the most common chronic disease among the Geriatric Population.

It is present in up to 18% of people older than 65 years.

The Geriatric Population has to spend four times more on health annually as compared to non diabetics.

The diagnosis and treatment of the Geriatric Population has its own challenges. Due to the physiological changes occurring due to the aging process, the elderly people may not present with classical symptoms.

This group is also different in many other ways -
1. Prevalence of complications in older population is much more ;
2. Older people have an increased prevalence of functional disability & comorbid illness that contribute to the complexity of managing diabetes.
3. Sometimes, older people are more prone to complications of treatment.
4. Special evaluation and goals of treatment need to be devised for the aged population.

The treatment of diabetics in older people needs not only attention to the common diabetic complications but also to the other comorbid conditions such as cognitive impairment,  falls and impaired body functions.

MANAGEMENT :
The management of Diabetes in elderly creates a double challenge of combining the principles of Geriatric Medicine with the Diabetes management for the geriatrician.

A) Goals of Diabetes management in elderly are more or less similar to the goals of any other diabetic. The main goals are :
1. Alleviation of hyperglycaemia;
2. Treatment of risk factors for atherosclerosis;
3. Identification and treatment of diabetic complications;
4. Diabetic self management education;
5. Prevention of development or worsening of diabetic complications;
6. Avoidance of Hypoglycaemic episodes;
7. Improvement of general health status.

The  overall health conditions of the individual dictates the Diabetes management goals. The  development of an individualized management plan that fits the goals and health status of each person is an essential part of diabetics care in the elderly.

B) Assessment of the Geriatric diabetic patient :
1. Comprehensive assessment of the health status;
2.  Assessment of the signs and symptoms related to hyperglycaemia and diabetic complications;
3.  Evaluation of hyperlipidaemia, hypertension, and other risk factors associated;
4.  Evaluation of the patient’s medications, dietary and exercise habits, nutritional,  functional, & cognitive status, social and economic status.
5. Complete & comprehensive assessment is essential in every Geriatric patient.  It should also assess for problems with but not limited to ophthalmic, neurological,  podiatric,  renal & other bodily functions.
6. Complete and detailed assessment is crucial as certain disease conditions and medications can lead to hyperglycaemia in the Geriatric Population.

TREATMENT OF HYPERGLYCAEMIA SYMPTOMS :
first and foremost is to control the hyperglycaemia symptoms. Many a times, the symptoms can be atypical and can include cognitive changes, delirium, anorexia, falls and incontinence.

PREVENTION AND TREATMENT OF DIABETIC DYSLIPIDAEMIA :
In older persons, the most significant morbidity & mortality is attributable to the atherosclerotic disease.
Smoking is one risk factor that scores over all the other risks tenfold. Stoping smoking improves the morbidity and mortality risks in elderly to a great extent.
Blood pressure management helps in lowering the risk of atherosclerosis in aged people. It also reduces the chances of coronary artery disease and stroke.
A large number of older diabetic people have dyslipidaemia and they should be regularly screened and treated. 

Diet, exercise and good glycemic control are the corner stone of treatment for dyslipidaemia.