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diabetes in the elderly

Management: - if multiple comorbidities, relax glycemic control - if insulin required, use once daily long-acting insulin - little evidence that fingerstick monitoring benefits patients with type 2 diabetes who are not taking insulin - hypoglycemia is a risk factor for dementia - increased risk of dementia with insulin (12%) vs metformin [2] or DPP4 inhibitor (RR=1.1) [3] - also see Diabetes mellitus type-1 &/or diabetes mellitus type-2

General

diabetes mellitus type 1 (insulin-dependent, juvenile) diabetes mellitus type 2 (insulin-resistant)

References

  1. American Diabetes Association Older adults: standards of medical care in diabetes-2021 Diabetes care 2021;44(supplement_1):s168-s179 PMID: 33298423
  2. Tucker ME One Type of Older Diabetes Drug Cuts Dementia Risk, Another Ups It. Medscape. Oct 11, 2022 https://www.medscape.com/viewarticle/982256 - Tang X et al Use of oral diabetes medications and the risk of incident dementia in US veterans aged >= 60 years with type 2 diabetes. BMJ Open Diabetes Research & Care. 2022 10(5): PMID: 36220195 PMCID: PMC9472121 Free PMC article https://drc.bmj.com/content/10/5/e002894
  3. Wu CW, Iskander C, Wang C et al Association of sulfonylureas with the risk of dementia: A population-based cohort study. J Am Geriatr Soc. 2023. Oct;71(10):3059-3070 PMID: 37218376 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18397
  4. Araki A. Individualized treatment of diabetes mellitus in older adults. Geriatr Gerontol Int. 2024;24(12):1257-1268 PMID: 39375857 PMCID: PMC11628902