Treatment of diabetes in older adults: 10 Key Takeaways
This year, the Endocrine Society released clinical practice guidelines on the diagnosis and management of diabetes and its comorbidities in older adults aged 65 years and above published May 1 in the Journal of Clinical Endocrinology & Metabolism.
Here are 10 key takeaways from the guidelines.
- Screen for diabetes and prediabetes (fasting sugar, A1c, 2-hour OGTT) in patients aged 65 years and older without known diabetes.
- Periodically screen older patients with diabetes for undiagnosed cognitive impairment. If mild cognitive impairment present, simplify medication regime and glycemic targets to improve compliance.
- Lifestyle modification is the first-line treatment of hyperglycemia in ambulatory patients with diabetes.
- Assess nutritional status to detect and manage malnutrition. In frail patients, use diets rich in protein and energy to prevent malnutrition and weight loss. Avoid restrictive diets.
- Metformin is the first choice oral hypoglycemic agent to treat diabetes, but not for patients who have significantly impaired kidney function (estimated glomerular filtration rate (eGFR) 30 mL/min/1.73 m2) or have a gastrointestinal intolerance. Add other oral hypoglycemic agents and/or insulin if glycemic control is not achieved with metformin and lifestyle management.
- Keep target BP140/90 mm Hg in patients with diabetes to reduce risk of cardiovascular disease outcomes, stroke and progressive chronic kidney disease (CKD). Use angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) as the first-line therapy in patients with diabetes and hypertension.
- An annual lipid profile and statins are recommended in patients with diabetes to reduce absolute cardiovascular disease (CVD) events and all-cause mortality
- Use low dose aspirin (75-162 mg/day) for secondary prevention of CVD after careful evaluation of bleeding risk and collaborative decision-making with the patient, family and other caregivers.
- Annual eye examination (by an ophthalmologist) to detect retinal disease; annual screening to detect CKD with eGFR and urine albumin-to-creatinine ratio.
- Minimize use of sedative drugs or drugs that promote orthostatic hypotension and/or hypoglycemia in patients with diabetes and advanced chronic sensorimotor distal polyneuropathy; refer to physiotherapy to reduce risk of fractures and fracture-related complications.
(Source: LeRoith D, et al. Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1520-1574).
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA
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Useful guidance. Thank you.