Managing diabetes in the elderly: Go easy, individualize
ABSTRACTThe care of elderly patients with diabetes should be individualized, taking into account the patient's comorbidities, other medications, cognitive abilities, home care situation, and life expectancy. Especially in frail, elderly patients, there should be less emphasis on strict glycemic control than on avoiding malnutrition and hypoglycemia and achieving the best quality of life possible.
KEY POINTS
- The diagnosis of diabetes in the elderly is often missed because its symptoms, such as dizziness, confusion, and nocturia, are often common and nonspecific.
- Elderly people at risk of malnutrition should have unrestricted meals and snacks; medications should be adjusted as necessary to control blood glucose levels.
- Tight control of blood glucose reduces the risk of death and diabetes-related complications but poses the risk of hypoglycemia.
SELF-MANAGEMENT IS IMPORTANT
Patient education is critical
Patient education is a cornerstone of diabetes self-management,62–66 and is especially important for patients who are cognitively impaired or who have limited language proficiency.Patient education is covered under Medicare Part B. Ample resources are available in print and electronic formats. Community resources can also be important.
Home glucose monitoring is simpler now
A patient’s insulin regimen should ideally be tailored according to home blood glucose level monitoring before and after meals and at bedtime. Medicare reimburses for once daily testing for patients who are not taking insulin and for three-times-daily testing for those taking insulin.
Elderly patients can be taught to reliably monitor their own blood glucose levels without diminishing their quality of life. Monitoring is now easier with new glucometers and test strips that use small amounts of blood. Testing can now also be performed on blood taken from the forearm, upper arm, thigh, or calf with the FreeStyle (TheraSense), One Touch Ultra (LifeScan) and Soft Tac (MediSense) meters. The Soft Tac meter lances skin and automatically transfers blood to the test strip, making use even easier. Talking glucometers are available for blind patients.
Coordination counts
A variety of models of chronic care delivery have been proposed. Regardless of which model is chosen, the complexities of management call for a multidisciplinary team approach, and coordination of care in order to ensure appropriate information flow becomes critical.
Editor’s note: In next month’s issue of this journal, Drs. Hornick and Aron will discuss the management of diabetic complications in the elderly, including coronary artery disease, neuropathy, and kidney disease.
