The number of elderly people with diabetes is growing rapidly
China has entered an aging country
High prevalence of hyperglycemia among the elderly in China
Geriatric diabetes treatment goals.
The treatment goals for geriatric diabetes are similar to those for adults in general
Near-term – to control the symptoms of diabetes and prevent acute metabolic complications
Long-term – to prevent chronic complications and improve the quality of life of diabetic patients through good metabolic control
Geriatric diabetes disease characteristics.
1. Prone to hypoglycemia.
Hypoglycemic symptoms are not obvious, and the tolerance to hypoglycemia is worse
2. Mostly accompanied by complications and comorbidities.
Cardiac, cerebrovascular, renal and other pathologies
Most hypoglycemia occurs unnoticed
Diabetes in the elderly is prone to hypoglycemia – DOVES*
Hypoglycemia is less likely to be detected in the elderly
Most hypoglycemia symptoms are mild and unrecognized.
344 cases 1, type 2 DM, mean age 65.5 years
Results: 80% were mildly symptomatic hypoglycemia, 97% benign, 3.4% severe hypoglycemia
Neurological symptoms of hypoglycemia were more common in.
170 DM patients 2, 70 years or older
Results: The most common symptoms were dizziness and other symptoms, hypoglycemic neurological symptoms were more common in younger patients, sympathetic excitation symptoms were less common and easily ignored
Hypoglycemic outcomes were more severe, with an increased risk of complications of
Myocardial infarction
Ventricular arrhythmia
Stroke
Trauma and fracture
Hypoglycemic patients have a higher mortality rate for all types of diseases
An 8-year mortality follow-up study of 14,670 patients with coronary artery disease in Israel
ACCORD Study – Exploring the Impact of Intensive Therapy
OBJECTIVE: To explore the impact of intensive glycemic control, elevated HDL-C and lowered triglycerides, and intensive blood pressure control on major CVD events
Study design: Randomized, multicenter, dual 2×2 analyses of 10,251 patients with type 2 diabetes were enrolled in the study
Patients enrolled had a mean age of 62 years, a mean disease duration of 10 years, and a history of cardiovascular disease or 2 or more cardiovascular risk factors
Study methods
Blood glucose
Intensive control (HbA1C 6.0%)
Standard control (HbA1C 7.0% – 7.9%)
Blood pressure
Intensive control (SBP<120mmHg)
Standard control (SBP<140mmHg)
Lipids
Betablocker to raise HDL-C to lower TG + statin to lower LDL-C
Statins only lower LDL-C
Preliminary results of the study
Intensive therapy in older patients with high-risk diabetes may be harmful
In older patients with type 2 diabetes combined with higher cardiovascular risk, intensive glucose-lowering therapy targeting A1c < 6% may increase the occurrence of cardiovascular endpoint events!
Geriatric diabetes Treatment requirements to prevent the occurrence of hypoglycemia
In the treatment of geriatric diabetes, the focus is on avoiding the occurrence of hypoglycemia rather than intensive therapeutic control of blood glucose, and the standard of glycemic control should follow the principle of individualization and may be slightly wider than that of the general population.
–2007 China Type 2 Diabetes Guidelines
The target range of glycemic control for geriatric diabetes can be slightly wider
Incidence of hypoglycemia of sulfonylureas and glinides
Acarbose in combination with sulfonylureas reduces the incidence of hypoglycemia
Geriatric diabetes is often associated with serious complications
Older patients with diabetes mellitus have a long history of serious complications, including
Coronary heart disease
Myocardial infarction
Stroke
diabetic nephropathy
……
Older patients should pay more attention to medication safety”
Metformin – a cardiovascular contraindication
Use metformin with caution in elderly patients
Use with caution in elderly patients over 65 years of age
Not recommended for patients over 80 years of age
Contraindicated in patients with hepatic insufficiency
Contraindicated in patients with renal insufficiency
contraindicated in patients with severe cardiopulmonary disease
contraindicated in patients with heart failure
Acarbose has no cardiovascular contraindications, has a good safety and tolerability profile, and reduces cardiovascular risk in diabetic patients
Geriatric Diabetes Precautions.
The treatment principles for geriatric diabetes are similar to those for adult diabetes in general, but the characteristics of the elderly should be taken into account.
Diabetes in the elderly mostly belongs to type 2 diabetes, most and lighter, so if the simple diet and exercise treatment can not meet the requirements, when choosing oral hypoglycemic drugs, should pay attention to the following matters: 1.
1, the elderly with the age of multi-organ function decline, with the kidney, heart, liver malfunction, avoid
The use of metformin is contraindicated for those with poor heart and liver function.
2, with cardiac insufficiency to avoid the use of thiazolidinediones.
3, avoid the first choice of strong action and long duration of sulfonylurea hypoglycemic drugs
Such as glibenclamide, etc. to avoid hypoglycemia.
4. Choose a-glucosidase inhibitors or small doses of mild-acting or
The insulin stimulants with mild action or short half-life can be chosen, and gradually increased according to the change of blood sugar.
The amount should be increased gradually according to the change of blood sugar.
Since the elderly have poor tolerance to hypoglycemia and the consequences are serious, the focus of treatment is to avoid hypoglycemia rather than to intensify blood glucose control. Blood glucose control standard should follow the principle of individualization and can be slightly wider than the general population.
–Cited from “China Type 2 Diabetes Guidelines (2007)”.
Summary
Older people with diabetes are prone to hypoglycemia, so the treatment standard should be relaxed appropriately to avoid hypoglycemia.
Comorbidities and complications are common in elderly diabetic patients, and attention should be paid to the safety of medication during treatment.