Diabetes (mellitus) in the elderly
Summary/Definition
With the increase in the elderly population, the incidence of diabetes mellitus among the elderly increases in direct proportion. This demonstrates the increasing risk of developing diabetes mellitus with age. According to the National Health and Healthy Eating Survey of Korean Citizens in 2020, 30.1% of adults aged 65 years and older have diabetes mellitus, which is about twice as high as 16.7% of adults aged 30 years and older. The main causes of diabetes mellitus are insulin resistance (a condition in which insulin action is reduced in peripheral tissues such as muscle, fat or liver tissue) and impaired insulin secretion, which affects older people more often. The effects of insulin resistance can be further exacerbated when accompanied by decreased muscle mass and increased abdominal (visceral) fat, decreased physical activity, and increased levels of stress hormones and medications. The elderly are more likely to have chronic diseases compared to other age groups and, as a result, take more medications
Symptoms
The typical pattern of diabetes mellitus in the elderly is that symptoms such as polydipsia, polyphagia and polyuria are subtle, but there are often vague signs such as fatigue and weakness, making it difficult to immediately recognise diabetes mellitus from the patient’s condition. Additionally, at the time of diagnosis, many elderly patients already have cardiovascular disease such as angina pectoris, stroke or chronic complications of diabetes mellitus.
Diagnostics
Because blood glucose levels in fasting blood sugar and postprandial glucose tests increase with age, different diagnostic criteria may be required than in middle-aged people. However, to date, studies that can clearly define such criteria have not been conducted. For this reason, the current diagnostic criteria for diabetes mellitus in the elderly are the same as in young and middle-aged people.
Treatment and course of the disease
Elderly patients with diabetes mellitus suffer from various comorbidities somehow related to diabetes (hypertension, coronary heart disease, stroke, etc.). In addition, the elderly present geriatric syndromes (taking multiple types of medications, depression, cognitive dysfunction, urinary incontinence, loss of consciousness, pain syndromes, etc.). Thus, elderly patients should indicate which medications they are currently taking when visiting a healthcare facility. Patients with reduced cognitive function should ensure that prescribed medications or insulin injections are administered correctly and that tests are performed to confirm the presence of cognitive dysfunction, dementia or depression. In addition, awareness of the disease and treatment methods is important for the management of a patient with diabetes mellitus, so it is recommended that they repeatedly participate in educational programmes on diabetes management methods to achieve appropriate outcomes. Elderly people are susceptible to the side effects of medications prescribed for the treatment of other comorbidities, which manifest themselves when the number of medications increases, and due to their improper administration or drug-drug interactions. Thus, every time an elderly patient visits the hospital, a comprehensive review of their treatment is required (checking the medications they are already taking, cancelling unnecessary medications, etc.).
