Feature Article

Diabetes as the years progress: how does management differ?

Sarah Abdo, Jeff R Flack

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Abstract

It is important to recognise the various functional, medical and social issues that the elderly population with diabetes face and to use the expertise of multiple disciplines to deliver a safe and effective management plan, which needs to be as simple to follow as possible.

Key Points

  • Older people with diabetes rarely present with the typical symptoms of hyperglycaemia.
  • Asymptomatic elderly people should be screened for undiagnosed diabetes by measurement of fasting plasma glucose levels as recommended for the general population.
  • Both type 1 (insulin dependent) and type 2 (noninsulin dependent) diabetes occur in the elderly.
  • Elderly people with diabetes should have regular comprehensive clinical and laboratory evaluation of metabolic control and screening for complications of diabetes.
  • Treating physicians should individualise the HbA1c target level in people with diabetes, taking into consideration the presence of cardiovascular disease, diabetes duration, diabetes medication regimen, comorbidities and problems with severe hypoglycaemia.
  • With the increasing duration of diabetes there will be an ongoing decline in pancreatic function, therefore, insulin will be essential for many people as the years progress.