Type 2 diabetes treatment plans may need to be different for older adults
Around6% of the world's populationsuffer from type 2 diabetes. People of any age can develop the condition, but thenumber of older adultswith type 2 diabetes israpidly increasing worldwide. In fact, adults over the age of 65 now account foralmost halfof all adult cases.
There are many ways type 2diabetescan be managed—including controlling weight throughdiet and exercise, or taking a drug to manageblood sugar levels. But many people may not realize that type 2 diabetes in older adults can bemore complicated to manage. This means people over 65 may need to be managed differently when it comes to type 2 diabetes.
There are a number of reasons why type 2 diabetes may be more difficult to manage in older adults. First, aging canaffect blood sugar control, as the body's organs (such as thepancreas, which controls insulin andbloodsugar levels) lose their ability to work as well as they used to.
On top of this, some research has shown that diabetes may cause people toage faster. It's thought that this is due to high levels of sugar in theblood streamprematurely aging the body's cells. This premature aging could lead to diseases associated with age-related decline (such as arthritis or dementia)happening sooner.
Frailty—a state of health that is associated withreduced physical and mental resiliencein older adults—also affects more people with type 2 diabetes than the rest of the population. In fact, anestimated 25%of older adults with type 2 diabetes are also frail. People who are frail and have type 2 diabetes havepoorer health and increased risk of deathfrom all causes compared to those who are not frail. Frailty is associated with reduced physical and cognitive functions andincreased riskof low blood sugar. Both of these factors can make treating type 2 diabetes more complicated.
Dementia, which is more common in older adults, may also make it more difficult to manage type 2 diabetes. This is because the memory problems this condition causes may make it harder for patients to remember totake their medication, or take the proper medication dosage. What's more, type 2 diabetes in older adults is actually a risk factor for developing dementia—includingAlzheimer's disease. While the link between the two isn't fully understood,elevated blood sugar levelsandinsulin not working properlyhave been suggested as causes.
Havingother health conditionscan also make it moredifficult to treat diabetes.Up to 40%of older adults with type 2 diabetes have four or more co-existing diseases—such as heart disease or dementia. These conditions can make it impossible to achievenormal treatment targetsand the drugs used to treat them can interact with those used to treat diabetes—which could lead to harm if not managed carefully. Alongside this,poor accessto proper medical care, and being more susceptible to low blood sugar in older age are also reasons whytreating diabetescan be so difficult in this age group.
Managing type 2 diabetes
Mostmedical treatmentsfor type 2 diabetes work tokeep blood sugar levels low, and prevent them from spiking. But older adults with type 2 diabetes may actually have an increased risk ofdeveloping dangerously low blood sugar levels. This usually happens if the medication is not used at the correct dose, or in people who have had diabetes for a long time.
Having verylow blood sugar levelsis dangerous as it canincrease the risk of falls—a serious and sometimes life-threatening problem in older adults. Very low blood sugar levels alsoincrease the risk of heart problems. This means thathealthcare professionalsneed to be careful they aren't being too aggressive in treatment plans for older adults to avoid causing other health problems.
Aging may also alter the body'sresponse to low blood sugar. This is significant, as when blood sugar falls too low it is extremely dangerous and can evenbe fatal.
Older adults may also be less able torecognize the symptomsof low blood sugar compared to young adults. This is because symptoms such as dizziness and confusion are often less specific in older adults, and can beconfused with dementia. Older adults may also takelonger to recoverfrom low blood sugar.
Given that repeated bouts of low blood sugar can mean that older people are less able tosense when it's happenedin the future, it's important that drugs prescribed to older adults for type 2 diabetes are given at the correct doses. Care especially needs to be taken prescribing insulin, the body'sblood sugar controlhormone, to very old adults as thissignificantly increasesthe risk of low bloodsugar.
Given our aging population, it is projected that moreolder adultswill have type 2 diabetes in the future. This makes it especially important to improve how we treat diabetes in this age group. Thoughspecific treatment guidelines have been developed, some evidence suggests that care approaches need to bemore cautious and personalizedto each patient, taking into account their other health conditions, and that treatments consider quality of life for each patient.
Explore further
This article is republished fromThe Conversationunder a Creative Commons license. Read theoriginal article.
