• Credits

  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

• Q. How prevalent is diabetes in ages > 65 years?

  • 26%

• Q. What is the link between diabetes and dementia?

  • Diabetics are at increase risk of
    • Alzheimers
    • Vascular dementia
    • All-cause dementia

• Q. Which agents have shown potential benefit in the improvement of mild cognitive decline in diabetics?

  • Intranasal insulin
  • Metformin

• Q. Which factors are associated with cognitive decline in diabetes?

  • Duration of diabetes
  • Uncontrolled diabetes

• Q. Is hypoglycemia also linked with dementia?

  • Yes

• Q. Why do the elderly have more risk of hypoglycemia?

  • Cognitive decline- do not remember medications, insulin dosing, SMBG, etc
  • Renal insufficiency
  • Progressive decline in counterregulatory hormone
  • Hypoglycemic unawareness

• **Treatment goals in elderly **

• Q. What should be the goals in otherwise healthy elderly diabetic free from comorbidities having long life expectancy?

  • HbA1 < 7.5%
  • Fasting 90-130 mg/dl
  • Bedtime 90-150 mg/dl
  • BP <140/90
  • Statins- given unless contraindicated

• Q. What should the treatment goals in complex elderly with multiple comorbidities, mild to moderate cognitive decline, and intermediate life expectancy?

  • HbA1 < 8%
  • Fasting 90-150 mg/dl
  • Bedtime 100-180 mg/dl
  • BP <140/90
  • Statins- give unless contraindicated

• Q. What is done for very complex elderly with poor life expectancy and moderate to severe cognitive decline with end-stage chronic diseases?

  • HbA1 < 8.5%
  • Fasting 100-180 mg/dl
  • Bedtime 110-200 mg/dl
  • BP <150/90
  • Statins- only if benefit exceeds risk

• **Pharmacological therapy **

• Q. How is creatinine assessed in the elderly?

  • The elderly may have less muscle mass hence creatinine may be lower than younger adults
  • Hence creatinine may be falsely low
  • The timed urinary collection is more useful

• Q. Why are Thiazolidinones (TZD) not a preferred choice of Oral antidiabetics (OAD) in the elderly ?

  • Thiazolidinone are linked with fracture hence use with caution in elderly

• Q. Which Sulphonylurea (SU) is relatively contraindicated in the elderly?

  • According to the American Academy of geriatrics it is best to avoid Glyburide (glibenclamide)

• Q. Which SU is safe in diabetics?

  • Short-acting SU like glipizide
  • Gliclazide- because it has low risk of hypoglycemia

• Q. What is the difference in response to hypoglycemia in the elderly?

  • They have less adrenergic symptoms and directly and more frequently develop neuroglycopenia symptoms

• Q. What are additional problems with hypoglycemia in the elderly?

  • Cardiac autonomic dysfunction
  • CV risk and risk of SCD
  • Dementia
  • Falls → Fracture

• Q. Can DPPIV be used as first-line therapy in the elderly?

  • Yes
  • However, they may not be very effective as monotherapy

• Q. Summaries the use of OAD in diabetics?

  • Glibenclamide, TZD- avoid
  • Other drugs – can be used

• **COMMON GERIATRIC PROBLEMS ASSOCIATED WITH DIABETES **

• Q. Is depression more common in elderly diabetics?

  • Yes

• Q. Does good glycemic control in the elderly increased the risk of falls or reduce the risk?

  • A study showed that intensive vs less intensive glycemic control in elderly- fall dependent upon the insulin use
  • Insulin – increases the risk of fall
  • Oral drugs- do not increase risk of fall

• Q. Enlist the other problems with old age and diabetes?

  • Urinary incontinence
  • Increase risk of falls
  • Polypharmacy
  • Dementia
  • Depression

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