Clinical Practice Guidelines
Diabetes in the Elderly

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Introduction

The definition of “elderly” varies, with some studies defining the elderly population as ≥60 years of age. Administrative guidelines frequently classify people >65 years of age as elderly. Although there is no uniformly agreed-upon definition of elderly, it is generally accepted that this is a concept that reflects an age continuum starting sometime after age 65 and is characterized by a slow, progressive impairment in function that continues until the end of life (1).

Section snippets

Diagnosis

As noted in the Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome chapter (p. S8), glycated hemoglobin (A1C) can be used as 1 of the diagnostic tests for type 2 diabetes in adults. Unfortunately, normal aging is associated with a progressive increase in A1C, and there is a significant discordance between fasting plasma glucose–based and A1C-based diagnosis of diabetes in this age group, a difference that is accentuated by race and gender (2). Pending

Reducing the Risk of Developing Diabetes

Lifestyle interventions are effective in reducing the risk of developing diabetes in elderly people at high risk for the development of the disease (3). Acarbose (4), rosiglitazone (5) and pioglitazone (6) also are effective in preventing diabetes in elderly people at high risk. Metformin may not be effective (3).

Glycemic control

As interdisciplinary interventions, especially those that have been specifically designed for this age group, have been shown to improve glycemic control in elderly individuals with diabetes, these people should be referred to a diabetes healthcare team 7, 8, 9. Pay-for-performance programs improve a number of quality indicators in this age group 10, 11. Telemedicine case management and web-based interventions can improve glycemic control, lipids, blood pressure (BP), psychosocial well-being

Hypertension

Treatment of isolated systolic hypertension or combined systolic and diastolic hypertension in elderly people with diabetes is associated with a significant reduction in CV morbidity and mortality and microvascular events. Also, the number needed to treat (NNT) reduces with increasing age 116, 117, 118, 119, 120. Treatment of isolated systolic hypertension may also preserve renal function in elderly people with diabetes (121). Several different classes of antihypertensive agents have been shown

Diabetes in Nursing Homes

Diabetes is often undiagnosed in nursing home patients 147, 148, 149, 150. The prevalence of diabetes is high in institutions, and individuals frequently have established macro- and microvascular complications, as well as substantial comorbidity 150, 151, 152, 153. Antipsychotic drug use is a risk factor for the development of diabetes in patients in institutions (154). In observational studies, the degree of glycemic control varies widely between different centres 147, 152, adherence to

Other Relevant Guidelines

Screening for Type 1 and Type 2 Diabetes, p. S12

Reducing the Risk of Developing Diabetes, p. S16

Organization of Diabetes Care, p. S20

Self-Management Education, p. S26

Targets for Glycemic Control, p. S31

Pharmacotherapy in Type 1 Diabetes, p. S56

Pharmacologic Management of Type 2 Diabetes, p. S61

Hypoglycemia, p. S69

Screening for the Presence of Coronary Artery Disease, p. S105

Dyslipidemia, p. S110

Treatment of Hypertension, p. S117

Erectile Dysfunction, p. S150

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