Dr. Ravi Sanker Elkrapati
MBBS, MRCP (UK), CCT-GIM, Diabetes and Endocrinology (UK)
Apollo Hospital, Jubilee Hills, Hyderabad
Treatment of diabetes in the elderly has its own challenges that need to be considered when planning treatment for diabetes in the elderly.
The prevalence of diabetes certainly increases with age. According to one estimate, about a quarter of the population over the age of 65 has diabetes. Some of them have multiple comorbidities such as kidney problems and heart disease that must be considered when planning treatment. In addition, some older people are addicted and live with the help of physical or financial support from others.
Add to the above. Polypharmacy (simultaneous use of multiple drugs by patients) is a concern, as many older people are taking multiple drugs for a variety of non-diabetes illnesses. This causes compliance issues, cost concerns, and complex drug interactions. Dysfunction and memory problems also do not solve the problem.
Given all of the above, diabetes healthcare providers have an individual’s overall health, risk of hypoglycemia, affordability, and expected survival in prescribing medications and devising individual care pathways. Should be considered. This also helps in planning a simple medication plan that patients and their caregivers can easily follow.
Screening for dementia and depression can be done during a clinic visit to a diabetes clinic for the elderly. This is to help detect, properly refer, and manage them. Hypoglycemia or hypoglycemia should be avoided, recognized and treated appropriately. This can be achieved through proper education of the patient and training of the caregiver. Setting realistic glucose goals and using drugs with a low risk of hypoglycemia are paramount.
Blood glucose targets in the elderly may need to be relaxed without being ambitious due to very strict glucose management. It may be necessary to relax the target HbA1c value, the 3-month sugar mean test “target value”. At the same time, it is essential to educate people about the need to avoid dehydration and prevent and treat huge spikes in blood glucose levels that can lead to dangerous complications of hyperglycemic coma.
Diabetes management includes regular screening for complications such as neuropathy, nephropathy, retinopathy, and heart disease and should be treated. High blood pressure and high cholesterol need to be properly treated with appropriate antihypertensive drugs and statins. Baby aspirin for the prevention of heart attacks, stroke may be shown in place.
Foot care is usually an area neglected by most elderly diabetics, causing ulcers and even amputations of the foot. Again, education, prevention of foot problems, and their screening are very important. Instead of walking barefoot, simple measures such as caring for cracks in the heel can be very helpful.
As elderly housing with care is becoming more common in India, it is imperative to train staff at such facilities on the following basics of diabetes treatment:
- Recognition and treatment of hypoglycemia
- Administration of insulin to elderly diabetics with dexterity or memory problems
Using a simple and practical dosing regimen with modern insulin that has a low risk of hypoglycemia will certainly help in this process.
Palliative care or care for terminal illness of diabetes requires regular treatment changes. Strict blood pressure and glucose control are not appropriate in such scenarios. Lipid-lowering drugs need to be discontinued, and in some circumstances overall discontinuation of treatment may be appropriate. Overall comfort, prevention of painful symptoms, and maintenance of quality of life and dignity should be the main goals.
Elderly people, especially diabetics, are at increased risk of succumbing to Covid-19 complications. Telemedicine portals may help to care for diabetics who are elderly in these Covid eras.
In summary, the challenges of treating diabetes in the elderly can be overcome using a simple strategy of combining common sense, realism and compassion for medicine and educating patients and their caregivers about the same thing.