[Diabetes in the elderly patient]

Abstract

Epidemiology: Diabetes mellitus in the elderly population is a major public health challenge. The aging population (over 65 years) now makes up 26.83% of the overall population in France and the prevalence of diabetes mellitus in this population is an estimated 10.3 to 20%.

Pathophysiology: The pathophysiology of diabetes is complex and mainly involves age-related insulin resistance. Changes in body fat, nutrition, and hormone secretions (insulin growth factor, dehydroepiandrosterone) also play an important role. Chronic hyperglycemia alone is pathogenic.

Complications: Most are severe and induce not only dramatic vascular complications, diabetic foot, retinopathy, and neuropathy, but also, in association with age-induced illnesses and frail homeostasis, produce a high rate of disablement and decay of quality of life.

Management: Current management of diabetes in the elderly population can be greatly improved. Systematic follow-up is essential, with special care to preserve self-independence. Education and self-monitoring play an important role. Large diet allowances are recommended. Available drug therapies for the elderly (basically insulin, short half-life sulfamides, metformine if renal function in normal, and exceptionally alpha-glucosidase inhibitors) must be examined in light of the specific situation of this frail population and the age-related changes in metabolism. Blood glucose control can be improved without risking unacceptable levels of hypoglycemia.