A new consensus report addresses a conundrum that looms large on the health care horizon: adults aged 65 years or older are more likely to have type 2 diabetes than any other age group, but clinicians have the least amount of information on how best to treat older patients with the illness.
The report is the result of a consensus development conference that the American Diabetes Association convened last February. Issues discussed in the report include disease progression, evidence for prevention and treatment, common comorbidities, and ways to individualize current clinical guidelines for elderly patients with diabetes. The document was published online today in both Diabetes Care and the Journal of the American Geriatrics Society.
“One important issue is that older people are a very heterogeneous population, which means that recommendations cannot simply be based on age,” Jeffrey Halter, MD, a member of the consensus panel, said in a statement. “It’s critical to consider overall physical and cognitive function, quality of life, and patient preferences when developing a treatment plan with an older patient.”
Because older patients with diabetes can have such varied health conditions, the report recommends that clinicians consider treatment goals for glycemia, blood pressure, and lipid levels based on 3 categories of patient characteristics: being relatively healthy; having multiple chronic illnesses or cognitive impairments; or having end-stage chronic illnesses or moderate to severe cognitive impairments or receiving long-term care.
Complications of diabetes that disproportionately affect older adults include major lower extremity amputation, heart attack, visual impairment, and end-stage renal disease, the report notes.
The Centers for Disease Control and Prevention has estimated that the prevalence of diabetes will double in the next 20 years, owing in part to the aging US population. Other projections indicate that diagnosed diabetes cases in adults aged 65 years or older will increase by 4.5-fold, compared with 3-fold in the general population, between 2005 and 2050.