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Diabetes in older people

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The number of people over the age of 65 with diabetes, principally type 2 diabetes, is growing. Increasing insulin resistance and reduced insulin secretion make age a major predisposing factor for type 2 diabetes.1

Patients are frequently asymptomatic, so macrovascular and microvascular damage may well be present by the time the diagnosis is made. Managing risk factors and established complications in the elderly should take account of co-morbidities, lifestyle and social setting, cognitive function and life expectancy, with a view to maximising autonomy and quality of life.2

Pharmacological treatment goals must be realistic and safe, acknowledging the metabolic consequences of age, the risks of hypoglycaemia and the dangers of polypharmacy.3 A holistic appraisal is essential and an individualised approach required.

Identifying diabetes

The classic osmotic symptoms of polyuria and thirst are often absent in the elderly. For many, the diagnosis is made at a routine health check or as part of investigations in an unwell patient. Groups at high risk of type 2 diabetes include those with a predisposing ethnic origin (south Asian, Afro-Caribbean and African), those with a family history of diabetes, and the obese, and there should be a low threshold for testing these groups. Patients at high cardiovascular risk or with overt cardiovascular disease (CVD) should also be screened for diabetes.


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