Type 2 Diabetes in the Elderly

According to the CDC, nearly 11 million Americans age 65 and older have diabetes. Thus, approximately 27 percent of our older patients are afflicted with this disease. Many are not diagnosed. I recently attended a diabetes symposium where Shantha Das, MD, Geriatrics and Gerontology Fellow at the Glenan Center for Geriatrics and Gerontology in Norfolk, VA spoke about diabetes in the elderly. Here are some of the take-aways from that session.Presentation: The physiological changes associated with aging may cause an atypical presentation of symptoms. Because the renal threshold for glucose increases with advanced age, glycosuria may not be present. Polyuria, polydipsia and polyphagia may also be absent. Instead, the presenting symptoms may be dry eyes, dry mouth, confusion, incontinence, dehydration with altered thirst perception, functional disability, cognitive decline, or complications relating to diabetes.Treatment: According to the American Geriatrics Society, a reasonable goal for relatively healthy and well-functioning adults is an A1C of <7%. However, an A1C goal of <8% is appropriate for frail adults with a life expectancy of less than 5 years and for those in whom the risks of intensive glycemic control may outweigh the benefits.All patients treated with hypoglycemic agents must know the signs of hypoglycemia. However, the onset and recognition of hypoglycemia in the elderly is variable. The typical symptoms of sweating and tremors may be absent. Instead, elderly patients may experience dizziness, weakness, delirium, confusion, and falls. Because of the morbidity and mortality associated with falls, extra care must be given to prevent hypoglycemia in elderly adults.Further confounding care are cognitive function, co-morbidities, polypharmacy, physical and functional disability, psychological issues such as depression, and the burden on the caregiver. Individualizing care is important for all of our patients with diabetes, regardless of age. Advanced age, however, may change the presentation, treatment, and goals of care.By Jill Weisenberger, MS, RD, CDE, author of Diabetes Weight Loss – Week by Week.National Diabetes Fact Sheet, 2011. Centers for Disease Control and Prevention. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdfKirkman MS, Briscoe VJ, et al. Diabetes in Older Adults: A consensus Report. Journal of the American Geriatric Society. 60: 1564-1570, 2012.