Indian Write-Ups

Management

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Profile of Diabetes Mellitus in the Elderly

Dr Yogini V Meisheri

Professor of Medicine,Seth G S Medical College, K E M Hospital, Mumbai

Table 1: Minimum Standards of Care for Older Adults with Diabetes Mellitus

Initial Evaluation :	Continuing Care :
Complete history and physical examination	Use of treatment as needed to meet target glucose levels, diet, oral agents, or insulin
Geriatric assessment (functional assessment, social support, economic status, nursing and social work assistance)	Assessment of blood glucose levels as frequently as needed to assure that treatment goals are being met
Laboratory examination: fasting blood glucose, glycosylated hemoglobin, fasting lipid profile, creatinine, urinalysis, and electrocardiogram	Annual assessment for diabetes complications
Ophthalmologic examination	Annual review of geriatric assessment
Dietary assessment

Special Attention to chronic complications:

Foot care: A standard care regimen for diabetic neuropathic foot ulcers is most likely to be effective for patients who have wounds that are small and of brief duration.
Painful diabetic neuropathy: Tricyclic antidepressants, amitriptyline and desipramine in particular, have been relatively well studied and shown to be effective. However, anticholinergic adverse effects may limit their usefulness and may preclude use in the elderly.
Coronary artery disease and control of dyslipidemia: Asymptomatic myocardial infarctions are three times more common in diabetic than in nondiabetic male patients. Comprehensive care should include not only normalization of the blood sugar, but also weight reduction, dietary fat restriction, strict blood pressure and lipid control, exercise and avoidance of tobacco.
health: can improve the quality of life.
Bone infections: Debridement and antimicrobial therapy form the mainstay in the management of osteomyelitis. Bone repair and bone mineral density may be significantly retarded in diabetic patients. These may be corrected by eliminating risk factors, supplementing the diet with calcium, bisphosphonates, and/or vitamin D, and treating with testosterone and/or estrogen when deficient.
Charcot Arthropathy: Studies conducted to date have not arrived at a consensus treatment recommendations.
Erectile dysfunction: Phosphodiesterase inhibitors are the treatment of choice for most patients.
Renal failure: Type 2 diabetes is the largest and fastest-growing single disease that requires dialytic therapy.

Future

Current systems allow only retrospective analyses, but real-time readings should be available in the near future. Such technological advance hold promise for preventing both hypoglycemia and hyperglycemia and for reducing the risk of long-term complications associated with diabetes. An artificial, mechanical islet cell may be the big next step toward bringing this disease under control. By combining continuous glucose monitoring data with continuous insulin delivery via an external or an implantable insulin pump, the outlook promises to be much brighter for patients with type 1 diabetes.

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