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Treatment of diabetes in older adults: 10 Key Takeaways
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New Delhi, May 25, 2019 :
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).
Author : Dr KK Aggarwal ,Padma Shri Awardee
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