Clinical management of elderly patients with type 2 diabetes mellitus

Postgrad Med. 2012 Jan;124(1):133-43. doi: 10.3810/pgm.2012.01.2526.

Abstract

With an increase in life expectancy of the general population comes an increase in the number of elderly patients with type 2 diabetes mellitus (T2DM). Although the pharmacologic treatment options for elderly patients with T2DM are the same as for younger adults, management of this growing group poses unique challenges. Changes in renal and hepatic function and an increased prevalence of multiple comorbidities mandate an individually tailored treatment strategy that balances treatment benefits with the patient's functional status and risk for hypoglycemia and polypharmacy. This approach is hampered by the relative paucity of data regarding the pharmacotherapy of T2DM in older adults, necessitating clinical guidance based on data extrapolated from a younger population. Most current guidelines are disease-focused and do not include specific instructions on how to prioritize the treatment of hyperglycemia relative to that of other comorbidities and the functional status of patients. This article reviews the epidemiology, pathophysiology, comorbidities, pharmacokinetic considerations, treatment goals, guidelines, and treatment options for the elderly population, and highlights the current knowledge gaps complicating the management of T2DM in this population.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Diabetes Complications
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemic Agents / pharmacokinetics
  • Hypoglycemic Agents / therapeutic use*
  • Practice Guidelines as Topic

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human