LAURA PART 2

Management of Type 2 Diabetes in Older Adults

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Management of Type 2 Diabetes in Older Adults

Introduction

The increased prevalence of aging populations around the world poses significant challenges to the health care systems, especially the management of chronic conditions like type 2 diabetes mellitus (T2DM). The elderly, who in this case refer to persons aged 65 years and older, have almost taken up almost half of all diabetes cases across the globe (Bellary et al., 2021). The agendas of aging are complicated by multimorbidity, frailty, and polypharmacy to manage T2DM in the group (Gado et al., 2024). T2DM among older adults is a critical issue to manage since uncontrolled glycemia is associated with cardiovascular disease, neuropathy, cognitive impairment, and functional dependency that reduces the quality of life and increases healthcare consumption. This paper focuses on the prevalence of T2DM among older adults globally, the role of technology in delivering healthcare and analyzes the use of continuous glucose monitoring (CGM) as an evidence-based practice that aids in better management of diabetes in the elderly population.

Global Burden of Disease Condition/Risk Factor

T2DM is a progressive metabolic disease, which is associated with the resistance to insulin, insulin secretion, and subsequent hyperglycemia. In the world, nearly 1 of every 11 adults is diagnosed with diabetes, and almost 90 percent of patients have T2DM (Bellary et al., 2021). The prevalence among older adults is 20-30% indicating the dynamic age-associated metabolic changes on the one hand and lifestyle habits, including physical inactivity and high adiposity on the other hand (Gado et al., 2024). The pathophysiology of the disease is multifactorial that includes reduced b-cell performance and decreased muscle mass, visceral adiposity, mitochondrial dysfunction, and chronic low-grade inflammation all of which play a role in insulin resistance and glucose intolerance (Bellary et al., 2021).

The clinical manifestation of T2DM is characteristically unusual in geriatric patients. Fatigue, weight loss, blurred vision, or confusion are some of the symptoms that can be confused with normal aging or other comorbidities (Gado et al., 2024). In addition, hyperglycemia and hypoglycemia are more likely to occur in the elderly because of impaired kidney function, polypharmacy, and dysfunctional counter-regulatory hormonal reaction (Doucet et al., 2023). Frailty, which is described as a deterioration of physiological reserves, is found in about a quarter of adults with diabetes in old age and augers well with hospitalization, disability, and death (Bellary et al., 2021).

References

Ajjan, R. A., Battelino, T., Cos, X., Del Prato, S., Philips, J. C., Meyer, L., ... & Seidu, S. (2024). Continuous glucose monitoring for the routine care of type 2 diabetes mellitus.  Nature Reviews Endocrinology,  20(7), 426-440. https://doi.org/10.1038/s41574-024-00973-1

Bellary, S., Kyrou, I., Brown, J. E., & Bailey, C. J. (2021). Type 2 diabetes mellitus in older adults: clinical considerations and management.  Nature Reviews Endocrinology,  17(9), 534-548. https://doi.org/10.1038/s41574-021-00512-2

Doucet, J., Gourdy, P., Meyer, L., Benabdelmoumene, N., & Bourdel-Marchasson, I. (2023). Management of glucose-lowering therapy in older adults with type 2 diabetes: challenges and opportunities.  Clinical Interventions in Aging, 1687-1703. https://doi.org/10.2147/CIA.S423122

Gadó, K., Tabák, G. Á., Vingender, I., Domján, G., & Dörnyei, G. (2024). Treatment of type 2 diabetes mellitus in the elderly–Special considerations.  Physiology International,  111(2), 143-164. https://doi.org/10.1556/2060.2024.00317