Management of hyperglycemia in geriatric patients with diabetes mellitus: South Asian consensus guidelines

Abstract

Asia is home to four of the world's five largest diabetic populations, two of them being South Asian nations, namely, India and Pakistan. This problem is compounded by a substantial rise in the elderly population in Asian countries. On the other hand, the heterogeneous health condition and multiple co-morbidities make the care of chronic disease in the elderly a challenging task. The aim of the South Asian Consensus Guidelines is to provide evidence-based recommendations to assist healthcare providers in the rational management of type 2 diabetes mellitus in the elderly population. Current Guidelines used systematic reviews of available evidence to form its key recommendations. No evidence grading was done for the purpose of this manuscript. The clinical questions of the guidelines, the methodology of literature search, and medical writing strategy were finalized by consultations in person and through mail. The South Asian Consensus guideline emphasizes tailoring of glycemic goals for patients based on age, co-morbid conditions especially that of cardiovascular system, risk of hypoglycemia, and life expectancy. It also recommends cautious use of available pharmacotherapy in geriatric patients with diabetes. The primary principle of diabetes therapy should be to achieve euglycemia, without causing hypoglycemia. Appropriate use of modern insulins and oral drugs, including incretin mimetics will help physicians achieve this aim.

Keywords: Diabetes mellitus; South Asia; elderly; geriatric; guideline.

Figure 1

A simple approach of switching over to premix insulin from basal insulin is shown here. Such a stepped approach is preferred when goals remain unmet (^*To achieve FBG 90–110 mg/dL and HbA1c <7.5%. Less stringent cutoff such as FBG 110–130, HbA1c <8% for patients who are frail, aged >75 years, having significant co-morbidities, ^**Please refer to the protocol shown in Table 7, ^***Please refer to the protocol shown in Table 8, OD: Once daily, BID: Twice daily, HbA1c: Glycated hemoglobin, FBG: Fasting blood glucose, Adopted and modified from Unnikrishnan et al.[69])