Clinical Review

Barriers to the Prevention and Treatment of Geriatric Diabetes

Health care providers need to empower older patients with individualized care plans to improve glycemic control and outcomes.

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Diabetes mellitus (DM) is a chronic disease that is commonly reported in older adults in primary care. Many adults aged > 65 years with DM have other chronic diseases that make management of their care more complex. Overseeing DM care in older adults while comanaging other chronic diseases is a challenge to health care providers (HCPs). The terms older adults and geriatric define persons aged ≥ 65 years.

Diabetes mellitus is growing at a rapid rate, and older adults are at higher risk. In 2012, about 29.1 million people in the U.S. (9.3%) were diagnosed with DM. Of that number, 11.2 million were aged ≥ 65 years. Additionally, 86 million adults had prediabetes when fasting blood glucose and A 1c levels were reviewed. Also in 2012, more than 400,000 new cases (11.5 per 1,000 people) were diagnosed in the aged ≥ 65 years group. 1-3 This age group is anticipated to double in 25 years, and the incidence of DM is projected to increase 3.2-fold. 4 By 2050, 26.7 million older adults—55% of the older adult population—will have DM. As a result, HCPs are faced with treating escalating numbers of older adults with DM as the population ages. 4

In 2012, the total cost of DM for the U.S. population was $245 billion: The direct cost of medical care was $176 billion, and the indirect costs in productivity, absenteeism, unemployment, disability, and premature death was nearly $69 billion. 2 This is a significant burden in terms of health care costs, productivity, disability, sick days, early retirement, and premature death. Diabetes mellitus increases atherosclerosis and thus accelerates the risk for heart disease, stroke, kidney disease, blindness, and limb amputations. 2

Managing DM concurrently with multiple chronic comorbid conditions is challenging. Patients are asked to bring blood glucose under tight control, perform regular blood glucose testing, take antiglycemic medications, watch their diet, lose weight, and exercise regularly—all while managing other chronic diseases. Many older patients are overwhelmed by the demands of self-management recommended by their HCPs. Similarly, HCPs are frustrated with their older patients, who are unable to adequately meet targeted goals for DM management and thereby reduce the associated risks for complications.

The purpose of this article is to discuss the common barriers to DM management, the experiences of patients and HCPs regarding those barriers, and the management strategies for overcoming barriers in treating older adults with DM.

What Are The Barriers?

The experiences of both patients and HCPs matter when working to overcome DM barriers. If no one understands the problem, no one can fix it. What concerns do patients and HCPs have? Do they really value each other’s perspectives? To overcome barriers, can HCPs and patients develop mutually agreed on goals that are reasonable and practical to implement within the framework of a partnership?

Patient Experiences

Continuity of care and access. Some older adults are seen by multiple HCPs during health care visits, and as a result, they receive mixed messages on what is expected of them. 3 Patients feel they have a greater sense of security and confidence when they have a therapeutic relationship with a trusted HCP; they feel more connected and confident about their health care system. 5

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