Type-2 Diabetes in Geriatric Patients

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Apr 7, 2023 Posted by admin

28.7 million people in the United States are currently diagnosed with Diabetes, and it is the 7th leading cause of death in the nation.1,2 Appropriate glycemic goals for geriatric patients may differ from other populations in order to balance the risk of complications with prevention of associated adverse effects from glucose lowering therapy. Adequate blood glucose control in elderly patients is especially important to prevent acute complications like hypoglycemia, dehydration, and poor wound healing. 3

Some special considerations for geriatric patients are as follows:

 

An A1C level represents average glycemic control over a 3-month period. 4

  • In most elderly populations, an A1C goal of 8% is a reasonable target.
  • For more complex patients, a shift of focus from A1C to blood glucose levels may be more appropriate.

 

 

Blood glucose targets may differ for elderly patients based on individual risk factors.3

 

Patient Characteristics Pre-prandial/Fasting Glucose Bedtime Glucose
  • Complex patients (multiple coexisting chronic illnesses)
  • 90 – 150 mg/dL
  • 100 – 180 mg/dL
  • Very complex/long term care patients
  • 100 – 180 mg/dL
  • 110 – 200 mg/dL

 

 

Hypoglycemia is a serious risk factor in geriatric populations.3

  • Caregivers and healthcare providers should be aware that elderly patients may be less likely to notice the signs and symptoms of hypoglycemia.
  • To avoid incidences of hypoglycemia, less aggressive treatment goals should be considered in geriatric patients.3

 

Medications that pose a high risk of hypoglycemia in geriatric patients:3

  • Insulin Secretagogues
    • Medications like glyburide, glipizide, repaglinide, and nateglinide
  • Thiazolidinediones
    • Medications such as rosiglitazone and pioglitazone
  • Insulin
    • Especially rapid-acting insulins

 

Treating geriatric patients with diabetes requires a highly individualized approach due to the heterogeneity of the patient population. When adjusting medication regimens for geriatric patients, it is essential to balance glycemic control with the associated risks of antidiabetic therapies.

References

  1. “National Diabetes Statistics Report.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 29 June 2022, https://www.cdc.gov/diabetes/data/statistics-report/index.html.
  2. “Diabetes Quick Facts.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 30 Sept. 2022, https://www.cdc.gov/diabetes/basics/quick-facts.html.
  3. ElSayed NA, Aleppo G, Aroda VR, et al., American Diabetes Association. Introduction and methodology: Standards of Care in Diabetes—2023. Diabetes Care 2023;46(Suppl. 1):S1–S4
  4. “Understanding A1C.” Understanding A1C | ADA, American Diabetes Association, https://diabetes.org/diabetes/a1c.  

 

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