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Diagnosis and management of diabetes in older people
Author(s) -
Kilvert Anne,
Fox Charles
Publication year - 2017
Publication title -
practical diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.205
H-Index - 24
eISSN - 2047-2900
pISSN - 2047-2897
DOI - 10.1002/pdi.2117
Subject(s) - medicine , diabetes mellitus , type 2 diabetes , life expectancy , incidence (geometry) , disease , weight loss , gerontology , diabetes management , pediatrics , obesity , population , endocrinology , environmental health , physics , optics
The incidence of diabetes has plateaued since 2004, although the prevalence continues to rise. The highest incidence is in people over the age of 70 years, most of whom have type 2 diabetes; a minority have type 1, which can present at any age. Type 1 diabetes may present more slowly in older people, a condition sometimes known as latent autoimmune diabetes in adults (LADA). Older people with diabetes have more than double the risk of cardiovascular disease compared to their non‐diabetic peers, and the risk of diabetes‐related major lower limb amputation is twice as high in those over 75 years compared with the 40–64 age group. Treatment targets for glycaemic control, blood pressure and cholesterol should be individualised in older people, taking into account factors such as functional status, life expectancy and comorbidities, including visual impairment. In some individuals the risk of adverse effects from medication (hypoglycaemia, postural hypotension) may outweigh the potential benefits. Treatment should be selected based on functional status and comorbidities, and changing circumstances such as declining renal function, declining appetite, weight loss or cognitive changes should prompt a medication review. Hypoglycaemia is a particular threat in this age group. There is a high prevalence of diabetes in care homes, which should have policies in place for screening for diabetes, the management of people with diabetes and training of staff. Copyright © 2017 John Wiley & Sons.