Recognizing the rising impact of diabetes in seniors and implications for its management.

OBJECTIVES: To identify the incidence and symptoms of type 2 diabetes in older adult patients, review appropriate glycemic targets for older adults with type 2 diabetes, and consider the rationale for managing hyperglycemia in this patient population.

DATA SOURCES: Live symposium presentation based on clinical practice and research, medical literature, and studies published between January 1993 and November 2008 on managing diabetes in older adults, government statistics, and medical society guidelines.

STUDY SELECTION: Thirty-five articles were identified from various data sources and were evaluated. The following search terms were used: Complications, Diabetes, Glucose Tolerance, Goals, Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS), Long-term Care, Management, Obesity, Prevalence, Risk Factors, Screening, Senior, and Symptoms. All information deemed relevant to recognizing the rising impact of diabetes in seniors and its implications for management were included.

DATA EXTRACTION: Data were extracted independently of the author by the librarians of the University of Pittsburgh.

DATA SYNTHESIS: As a result of the aging of the U.S. population, the increasing prevalence of diabetes, and the considerable impact of this disease among older adults, it is only logical to assume that the number of older individuals with diabetes and its impact on older adults will continue to rise. Uncontrolled diabetes has significant risks in the elderly beyond the typical microvascular and macrovascular complications commonly associated with diabetes: cognitive impairment, depression, excessive skin problems, and an increased risk of falls. However, glycemic control reduces the development of these complications and can lead to improvements in dementia, memory, energy, physical activity, mood, and quality of life.

CONCLUSION: Because many older adults may benefit from intensive, long-term glycemic control, consultant pharmacists should understand the importance of individualizing glycemic targets, management strategies, and pharmacotherapy in older adults.