Caring for an Older Person with Diabetes Mellitus

Diabetes Mellitus Recommendations

Summary of Key Recommendations:

  • Older persons with diabetes should be offered individualized therapy that takes into consideration life expectancy, functional status, the presence of cognitive impairment, social support and patient preferences.
  • Care should be kept simple and inexpensive, wherever possible.
  • Older persons with diabetes are likely to benefit greatly from cardiovascular risk reduction, therefore monitor and treat hypertension and dyslipidemias.
  • For many older persons, treatment of hypertension may require more than one medication to achieve adequate control. Treatment should be gradual if possible and persons should be monitored for drug interactions and side effects.
  • Monitor and treat hyperglycemia, with a target A1C of 7%, but less stringent goals of therapy may be appropriate once patient preferences, diabetes severity, life expectancy and functional status have been considered.
  • Encourage diabetes education and make patients and their families aware that it is a covered benefit under Medicare.
  • Dilated eye examinations should be performed every two years at a minimum, and more often if there are additional risk factors for diabetic eye disease or evidence of age-related eye disease.
  • Maintain an updated medication list and evaluate the patient regularly for adverse medication effects.
  • Older persons with diabetes should be screened for depression, and if depression is identified, therapy should be offered and response to therapy monitored.
  • Persons should also be screened annually for cognitive impairment, urinary incontinence, injurious falls and persistent pain since these conditions are more prevalent among older persons with diabetes.

Listed below are several brochures on aging and diabetes available from AGS at Living with Diabetes:

  • "Medications for Diabetes," a resource on safe use of insulin and other drugs used to treat diabetes and related complications.
  • "Diabetes Patient Education Forum," a physician-authored Q&A that answers common questions older patients may have about diabetes.
  • "Diabetic Neuropathy," a pamphlet designed to help patients and caregivers understand and manage neuropathic pain.
  • "Lifestyle Changes for Living with Diabetes," a brochure that addresses glycemic control, blood sugar monitoring, nutrition, diet, exercise and lifestyle modifications.
  • "Managing the Complications of Diabetes," a series of resources addressing management of hypertension, overactive bladder, falls, depression and cognitive impairment.

From the California Healthcare Foundation/American Geriatrics Society (AGS) Panel on Improving Care of Elders with Diabetes. "Guidelines for Improving the Care of the Older Person with Diabetes Mellitus." J Am Geriatr Soc 2003

The development of these guidelines was supported by the California Healthcare Foundation's Program for Elders in Managed Care and an unrestricted educational grant from Aventis Pharmaceuticals.

Source: American Geriatrics Society

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