Diabetes mellitus – geriatric syndroms, aims and therapeutic options in the elderly

Authors: P. Weber;  H. Meluzínová;  D. Prudius
Authors‘ workplace: Klinika interní, geriatrie a praktického lékařství LF MU a FN Brno
Published in: Geriatrie a Gerontologie 2014, 3, č. 4: 194-198
Category: Review Article


Diabetes mellitus (DM) occurs in elderly patients often in the context of multimorbidity and may participate in the creation and development of significant disability. It can then significantly influence all other diagnostic and therapeutic procedures. Treatment of DM in old age is based on the same principles as in younger individuals: diet, physical activity, eventually drugs. The goals that need to be taken into account when selecting therapy DM are: diabetic age, including life expectancy, the presence of macro-and microangiopathic complications, degree of self-sufficiency, family environment and economic conditions, nutritional habits (including condition of teeth), other disabilities – mental, motor, visual and auditory. This article briefly describes the therapeutic possibilities of DM.

diabetes mellitus – old age – geriatric syndromes – goals of treatment – treatment options


1. Humes D (ed. in chief): Kelley’s Textbook of Internal Medicine. Philadelphia, USA: Lippincott Williams and Wilkins 2000.

2. Hunter JA, Haslett C, Chilver AR, Boon NA, Colledge A (eds.): Davidson’s Principle and Practice of Medicine. 19 vyd. Edinburgh, UK: Churchill Livingstone 2002.

3. Knowler WC, Barrett-Connor E, Fowler SE, et al.: Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6): 393–403.

4. Saito T, Watanabe M, Nishida J, et al.: Zensharen Study for Prevention of Lifestyle Diseases Group. Lifestyle modification and prevention of type 2 diabetes in overweight Japanese with impaired fasting glucose levels: a randomized controlled trial. Arch Intern Med 2011; 171(15): 1352–1360.

5. Araki A, Ito H: Diabetes mellitus and geriatric syndromes. Geriatr Gerontol Int 2009; 9(2):105–114.

6. Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P: Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol 2006; 5(1): 64–74.

7. Whitmer RA, Karter AJ, Yaffe K, et al.: Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 2009; 301(15): 1565–1572.

8. Maraldi C, Volpato S, Penninx BW, et al.: Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79year old persons: the health, aging, and body composition study. Arch Intern Med 2007; 167(11): 1137–1144.

9. Brown JS, Wing R, Barrett-Connor E, Nyberg LM, et al.: Diabetes Prevention Program Research Group. Lifestyle intervention is associated with lower prevalence of urinary incontinence: the Diabetes Prevention Program. Diabetes Care 2006; 29(2): 385–390.

10. Schwartz AV, Hillier TA, Sellmeyer DE, et al.: Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care 2002; 25(10): 1749–54.

11. Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, Tuttle K, Douglas J, Hsueh W, Sowers J: Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 2000; 36(3): 646–661.

12. Nathan DM, Buse JB, Davidson MB, et al.: Medical management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009; 32(1): 193–203.

13. Ryden L, Standl E, Bartnik M, et al.: Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The task force on diabetes and cardiovascular diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 2007; 28(1): 88–136.

14. Sharma V, Aggarwalb S, Sharma A. Diabetes in Elderly: J En-docrinol Metab 2011; 1(1): 9–13.

15. American Diabetes Association. Standards of Medical Care in Diabetes – 2013. Diabetes Care 2013; 36(Suppl.1): S11–S66.

16. Sinclair AJ, Paolisso G, Castro M, et al.: European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab 2011; 37(Suppl. 3): S27–S38.

17. Bramlage P, Gitt AK, Binz C, et al. Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia. Cardiovasc Diabetol 2012; 6(10): 111–122.

18. Pamela Allweiss & Ann Albright. Diabetes, disasters and decisions. Diabetes Management 2011; 1(4): 369–377.

19. Sanz C, Gautier JF, Hanaire H. Physical exercise for the prevention and treatment of type 2 diabetes. Diabetes Metab 2010; 36(5): 346–351.

20. Qin L, Knol MJ, Corpeleijn E, Stolk RP. Does physical activity modify the risk of obesity for type 2 diabetes: a review of epidemiological data. Eur J Epidemiol 2010; 25(1): 5–12.

21. Fravel MA, McDanel DL, Ross MB, et al. Special considerations for treatment of type 2 diabetes mellitus in the elderly. American Journal of Health-System Pharmacy 2011; 68(6): 500–509.

22. Grossman S. Management of type 2 diabetes mellitus in the elderly: role of the pharmacist in a multidisciplinary health care team. J Muldiscip Healthc 2011; 4: 149–154.

23. Al-Maatouq M, Al-Arouj M, Assaad SH, et al. Optimising the medical management of hyperglycaemia in type 2 diabetes in the Middle East: pivotal role of metformin. Int J Clin Pract 2010; 64(2): 149–159.

24. Abbatecola AM, Maggi S, Paolisso G. New approaches to treating type 2 diabetes mellitus in the elderly: role of incretin therapies. Drugs Aging 2008; 25(11): 913–925.

25. Aquilante CL. Sulfonylurea pharmacogenomics in Type 2 diabetes: the influence of drug target and diabetes risk polymorphisms. Expert Rev Cardiovasc Ther 2010; 8(3): 359–372.

26. Doggrell SA, Tuli R. Dapagliflozin – do we need it registered for type 2 diabetes? Expert Opin Pharmacother 2014; 15(11): 1631–1635.

27. Bailey CJ. Diabetes: insulin plus metformin for DM2 – are there benefits? Nat Rev Endocrinol 2012; 8(8): 449–450.

28. Saudek CD, Golden SH. Feasibility and outcomes of insulin therapy in elderly patients with diabetes mellitus. Drugs Aging 1999; 14(5): 375–385.

29. Barag SH. Insulin therapy for management of type 2 diabetes mellitus: strategies for initiation and long-term patient adherence. J Am Osteopath Assoc 2011; 111(7 Suppl 5): S13–S19.

30. Weng J, Li Y, Xu W, et al.: Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial. Lancet 2008; 371(9626): 1753–1760.

31. Chen HS, Wu TE, Jap TS, et al.: Beneficial effects of insulin on glycemic control and beta-cell function in newly diagnosed type 2 diabetes with severe hyperglycemia after short-term intensive insulin therapy. Diabetes Care 2008; 31(10): 1927–1932.

32. Haluzík M a kol. Praktická léčba diabetu. 2. vyd. Praha: Mladá fronta 2013.

33. Rodbard HW, Jellinger PS (Cochairpersons), Bloomgarden ZT, et al.: AACE/ACE Glycemic Control Algorithm Consensus Panel. Endocr Pract 2009; 15(6): 540–559.

34. Qayyum R, Bolen S, Maruthur N, et al.: Systematic review: comparative effectiveness and safety of premixed insulin analogues in type 2 diabetes. Ann Intern Med 2008; 149(8): 549–559.

35. Weng J, Li Y, Xu W.: Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial. Lancet 2008; 371(9626): 1753–1760.

Geriatrics General practitioner for adults Orthopaedic prosthetics
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