CEO, Abyad Medical Center
Chairman, Middle-East Academy for Medicine of Aging
Disorder of carbohydrate metabolism in the elderly population appears to be closely linked to the aging processes. The prevalence of diabetes mellitus and glucose intolerance increases with age and it is estimated to affect 40 % of individuals above the age of 65.
For the caregivers the appropriate treatment goal of older diabetic patients may be difficult to determine as there is little scientific information available to guide decision-making.
For the ‘younger’ geriatric patient (65- 75 years) with few other major medical problems, fairly tight control of blood glucose may be the most appropriate goal, as these patients have a longer life expectancy, which will allow for the development of the chronic complications of diabetes mellitus. For the older diabetic patient with multiple medical problems and reduced life expectancy, simple prevention of symptoms from hyperglycemia is probably the most appropriate therapeutic goal.
As in younger patients, diet is a major component of the treatment of diabetes mellitus. A weight-reducing diet may be appropriate for older patients who are overweight. However, it is unrealistic to expect any more success with weight-loss regimens than in younger patients.
The use of exercise as a means of treatment for the control of glycaemia continues to be controversial. Although no studies have specifically addressed the role of exercise in elderly diabetic patients, benefits demonstrated by studies of exercise programs have included improvement in peripheral insulin sensitivity and a relative increase in the proportion of lean body mass.
When diet and exercise are not sufficient to be therapeutic, then treatment with oral hypoglycemic agents will be necessary.
Insulin therapy is appropriate for any patient for whom treatment goals cannot be met by diet, exercise, and oral agents combined.
The advantage of insulin therapy is the potential for excellent glycemic control, along with adjustable dosing to cover changes in diet, exercise and health status. The disadvantages of insulin therapy include the difficulties of administering it, the necessity for frequent blood glucose monitoring at home, and the potentially increased risk of hypoglycemia.
Multiple skills are needed for patients to be independent in the administration and monitoring of insulin. Many of these skills, which are taken for granted in younger individuals with diabetes, must carefully be assessed in older diabetic patients. They include sufficient cognitive function to manage a complex regimen involving insulin and diet (adequate sight for reading labels, syringes, and fine motor control to draw up insulin and administer it).
Sometimes the best option is to admit the patient to hospital for initial diabetes control and education. The decision to admit for insulin therapy must be made on an individual basis, dependent upon the patient, the patient’s support system, and the community health services available to support the institution of insulin therapy as an outpatient.