Management of type 2 diabetes in the elderly patient

Autores: Bello Chavolla Omar Yaxmehen, Aguilar Salinas Carlos Alberto

Resumen

Type 2 diabetes is a rising global problem; elderly patients have the highest prevalence and their management is complicated by the presence of comorbidities and age-related changes. When establishing a treatment regime for elderly individuals, concerns in terms of functional status, living arrangements, the presence of frailty, cognitive impairment, and risk of hypoglycemia must be considered before selecting specific treatments. Geriatric assessment must be sought to maximize the potential benefit of treatment. Glycemic targets must take into consideration the presence of comorbidities, life expectancy, and the risks associated with tight glycemic control. In general, HbA1c goals between 7.5-8.0% are regarded as appropriate for elderly individuals. Regardless, goals must be adjusted in relation to treatment response and expected complications. Diet therapy and physical activity are the cornerstone of treatments to improve glycemic control and maintain an adequate functional status; pharmacological first-line therapy includes the use of metformin, which carries a low risk of hypoglycemia and has been associated with improved outcomes. Consideration of combined therapy must be weighed against hypoglycemia and cardiovascular risk, expected adverse reactions, and potential benefits fron more intensive treatment regimes. Cardiovascular risk management must be focused on hypertension management and lifestyle changes such as cessation of smoking and moderate weight loss; statin use must be individualized considering life expectancy, cognitive status, and the presence of frailty to improve benefits.

Palabras clave: Type 2 diabetes management metformin frailty antidiabetic medication.

2017-06-09   |   207 visitas   |   Evalua este artículo 0 valoraciones

Vol. 3 Núm.1. Enero-Junio 2017 Pags. 26-36 J Lat Am Geriatric Med 2017; 3(1)