Diabetes mellitus in advanced age – diabetologist’s and geriatrician’s view
|Year of publication
|MU Faculty or unit
|Diabetes mellitus (DM) is a heterogeneous syndrome which is marked by hyperglycemy, insulin effect deficiency (absolute or relative), simultaneous changes of metabolism of lipides and proteins and an inclination to development of chronical and acute complications. In gerontology it is clinically the most frequent and extremely serious metabolic disorder. Senior patients suffer predominantly from DM of the type 2 (70+ up to 95%). DM 2 development is caused mainly by 1. insuline resistance; 2. Impaired insulin secretion; 3. Impaired gluconeogenesis supression. DM2 in advanced age stems from an interaction of genetic predisposition and an environmental influence. Of particular importance are nutritional habits, modern lifestyle, stress and minor physical activity. Clinical manifested DM2 is preceeded by insulin resistance (IR) with a decrease of insulin biological effectivity and it is generally presumed that the latent period duration is about 6-12 years without any subjective difficulties. DM is a significant risk factor for an incurrence and development of late diabetic complications both micro- and macroangiopathic. Their prognosis does not depend much on particular type but rather on the period of the disease duration and the age of its discovery. The progress of atherosclerosis is several times quicker with diabetics (when compared to non-diabetic patients). Therapeutic options for DM2 in senium are diet, enhanced physical activity, various oral antidiabetic drugs, insulin and education. When selecting an appropriate treatment it is necessary to consider diabetic’s age (including life expectancy); macro- and microangiopathic complications; self-sufficiency level; family environment and economic situation; nutritional habits (incl. dentition status); other handicaps – psychic, motoric, visual and aural. Main goals of treatment the older diabetics are: 1) limitation of symptoms of hyperglycemy, 2) realistic evaluation of an impact simultaneously occuring diseases (coronary heart diseases, etc.), 3) maintenance of optimum weight and physical activities, 4) minimalisation of the risks of hypoglycemies and other undesirable effects of the DM treatment, 5) retrieval of complications and prevention from their development, 6) timely improvement of contingent disability by means of available compensation aids, 7) keeping the old diabetic in the mood of overall welfare and selfsufficient quality life in a community as long as possible.