Approach Toward Diabetes Treatment in the Elderly

Özet

Concomitant diseases in elderly individuals with diabetes (renal failure, heart failure, ischemic heart disease, stroke, urinaryincontinence, cognitive impairment, dementia, sarcopenia, and osteoporosis) make diabetes management difficult. Therefore,other comorbid conditions should be taken into account in elderly diabetics when considering a treatment approach. Theuse of oral antidiabetic agents in individuals older than 75 years may be limited. Although the diabetes treatment is not anydifferent in healthy elderly patients, hypoglycemia is one of the most feared conditions, especially in the elderly. Therefore,metformin, DPP-IV inhibitors, and SGLT2 inhibitors should be considered in the first place with less risk of hypoglycemia. Lowdose sulfonylureas may also be used in selected cases. The use of new antidiabetic drugs, such as GLP-1 anologues and SGLT2inhibitors, has strengthened our ability to cope with the risk of hypoglycemia and cardiovascular events, which are the two mostimportant drawbacks in the treatment of elderly people with diabetes. Insulin treatment should be individualized, and the mostrare injection regimens should be used. In case of failure of OAD, basal insulin should be added to the current treatment, andif necessary, a basal + plus regimen should be planned by adding bolus insulin 1/2/3 times per day to the meals. As a result, inelderly diabetics, an inadequate treatment or excessive treatment and individualizing the treatment should be the most appropriate approach.