Managing Diabetes in Older Patients: Consensus Report

What is known about diabetes mellitus (DM) in older adults, how DM affects them differently than younger adults, what can be done to prevent or manage the disease, and how best to fill critical gaps in the evidence to address older patients’ needs are outlined in a consensus report published jointly by the American Diabetes Association (ADA) and the American Geriatrics Society (AGS). Although DM occurs more frequently in patients 65 years and older than in any other age-group, and the nation’s population continues to age, researchers and clinicians have the fewest data about how to treat older patients with DM, the report concluded.

The consensus report, “Diabetes in Older Adults,” offers highlights of what was learned in a Consensus Development Conference on Diabetes and Older Adults convened earlier this year. They include the following areas:

+ The epidemiology and pathogenesis of DM in older adults.

+ Evidence for preventing and managing DM and its most common comorbidities in older adults.

+ Current guidelines for treating older adults with DM.

+ Issues that need to be considered in individualizing treatment recommendations.

+ Consensus recommendations for treating older adults with or at risk for DM.

+ How gaps in the evidence can be filled.

Key points in the ADA/AGS report include the following:

+ Because older persons are a heterogeneous population, recommendations cannot be based solely on the patient’s age. In developing a treatment plan, clinicians need to consider the patient’s overall physical and cognitive function, quality of life, and preferences.

+ As persons age, insulin resistance increases and pancreatic islet cell function decreases, placing patients at risk for type 2 DM. The epidemic of type 2 DM in the United States is exacerbated by the aging of the population as well as by increasing overweight and obesity, it was noted.

+ More than one-fourth of adults 65 years and older have DM, and about half have prediabetes. The rate of DM-related lower limb amputations, heart attacks, vision problems, and kidney failures is highest in older adults with DM, especially in those older than 75 years.

In developing the consensus recommendations, the panel considered older adults with DM in 3 groups: those in relatively good health, those with complex medical histories, and those with significant comorbid illness and functional impairment. Different screening and treatment recommendations were made for each group. The panel also recommended that further research be conducted that takes into account the complexity of issues that older patients face.