Feature Article

Diabetes in older people: how does management change?

Kay Hau Choy, Jeff Flack

Figures

© filadendron/istockphoto.com model used for illustrative purposes only
© filadendron/istockphoto.com model used for illustrative purposes only

Abstract

Diabetes in older adults is a growing health burden in Australia and presents various challenges. The heterogeneity of older people, ranging from the robust to the frail, should be strongly considered when developing treatment goals and strategies. Diabetes care in older people generally has a greater emphasis on maintaining quality of life, delivering personalised care, achieving comfort, and preventing symptoms and acute complications of hyperglycaemia.

Key Points

  • The heterogeneity of older individuals merits strong consideration when establishing treatment goals and strategies.
  • Older adults with diabetes are more susceptible to adverse drug effects, hypoglycaemia and infections due to a myriad of factors.
  • Clinical manifestations of diabetes in older people are atypical.
  • Diabetes care in older people typically has less emphasis on strict numerical targets and more focus on symptomatic wellbeing, avoidance of treatment complications, personalised care, pharmacovigilance and rationalisation of medications.
  • Therapeutic agents with proven tolerability and safety, and minimal hypoglycaemic risk should be preferred.
  • Individualised therapeutic approaches and glycaemic target ranges are crucial in providing safe and effective diabetes care to older people.

Figures

© filadendron/istockphoto.com model used for illustrative purposes only
© filadendron/istockphoto.com model used for illustrative purposes only