Treating diabetes in older adults requires simpler medication regimens, looser glycemic targets

The guideline, titled “Treatment of Diabetes in Older Adults: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the May 2019 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of the Endocrine Society. The guideline focuses on treatment strategies that take into consideration the overall health and quality of life of older adults with diabetes, defined as age 65 or older.

Aging plays a major role in the development of diabetes, which currently affects an estimated 33 percent of older adults in the U.S. Older adults with diabetes often have one or more co-existing conditions such as cognitive impairment, cardiovascular disease, impaired vision, and rheumatoid arthritis, which affect diabetes self-management.

“The guideline encourages clinicians to consider available evidence and a patient’s overall health, likelihood to benefit from interventions and personal values when considering treatment goals such as glucose, blood pressure, and cholesterol,” said Derek LeRoith, M.D., Ph.D., of Mount Sinai School of Medicine in New York, N.Y. LeRoith chaired the writing committee that developed the guideline. “Our framework prioritizes blood glucose targets over the hemoglobin A1c test when managing diabetes in older adults.”

Recommendations from the guideline include:

  • Simplifying medication regiments and tailoring glycemic targets in older adults with diabetes and cognitive impairment (e.g. dementia) to improve compliance and prevent treatment-related complications
  • Designing outpatient diabetes regimens specifically to minimize hypoglycemia
  • Targeting blood pressure levels of 140/90 mmHg to decrease the risk of cardiovascular disease outcomes, stroke, and progressive chronic kidney disease in older adults with diabetes aged 65 to 85 years
  • Using an annual lipid profile to reduce the amount of “bad cholesterol” in the blood
  • Administering annual comprehensive eye exams to detect retinal disease
  • Establishing clear blood sugar targets for older adults with diabetes in hospitals or nursing homes at 100-140 mg/dL (5.55-7.77 mmol/L) fasting and 140-180 mg/dL (7.77-10 mmol/L) after meals while avoiding hypoglycemia

Top Articles

Parasitic worms cause cancer — and could help cure it

Billions worldwide are infected with tropical worms. Unsurprisingly, most of these people live in poor countries, kept poor by the effects of worm-related malnourishment. What may surprise many is that worms also cause the majority of cases of some cancers in these countries.

Read More

Sharp increase in falls in women during midlife

Falls are not just a problem of advanced age, according to researchers, who have identified a sharp increase in falls after the age of 40, particularly in women.

Read More

Phytochemicals: beyond vitamins

Phytochemicals are non-nutritive chemicals in plant foods that protect plants from microbial invasions and infections.

Read More

Latest News

Shingles vaccine may also reduce stroke risk

The shingles vaccine appears to reduce stroke risk by about 16% in older adults. In addition, the shingles vaccine may offer the strongest protection against stroke for people younger than 80.

Read

Oh my aching back: Do yoga, tai chi or qigong help?

About 80 percent of Americans will experience low back pain at some point. Patients are often advised to manage their back pain with exercise and mind-body interventions. But, do they really help? Researchers compared and contrasted yoga, tai chi and qigong, and found them to be effective for treatment of low back pain, reporting positive outcomes such as reduction in pain or psychological distress such as depression and anxiety, reduction in pain-related disability, and improved functional ability.

Read

Living near major roads linked to risk of dementia, Parkinson’s, Alzheimer’s and MS

Living near major roads or highways is linked to higher incidence of dementia, Parkinson’s disease, Alzheimer’s disease and multiple sclerosis (MS), suggests new research.

Read

“Our bodies are our gardens - our wills are our gardeners.”

William Shakespeare