Treating Diabetes in Older Adults – Optimising Glycaemic Targets with Comorbidities in Mind

ABSTRACT

@#Ageing is associated with changes in the body composition, reduced insulin sensitivity and beta-cell function, which predispose the older adults to glucose intolerance and a higher risk of diabetes mellitus. The diabetes treatment for older adults is complicated by higher rates of coexisting illnesses, functional and physical disability, cognitive impairment, and more prone to injury. The treatment goal is less stringent, with a reasonable HbA1c between 7.0 to 8.0 percent, with the aim to minimise the risk of hypoglycaemia. Medical nutrition therapy and physical activity are the cornerstones in the management, failing so, pharmacotherapy with oral or injectable diabetes medication would be needed for diabetes control. The Appropriate Care Guidelines, Ministry of Health, on Oral Glucose-Lowering Agents, and Initiating Basal Insulin in type 2 diabetes mellitus, published in 2017, have provided the framework for the use of oral glucose-lowering agents and insulin therapy for diabetes management in the general population. The diabetes management plan includes a multidisciplinary team, a greater consideration of patient factors, aspiration and goals, and risk evaluation and mitigation strategy to prevent hypoglycaemia. Easy and early access to health care is critical as older adults are prone to rapid deterioration in the clinical condition.