The Endocrine Society has just released its guidelines on how to manage the elderly with diabetes. Guidelines are overall similar to those of ADA and AACE but with greater emphasis in avoidance of adverse events; such as hypoglycemia, malnutrition, excessive weight loss, frailty, falls, and drug side effects. See below for more details.
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- In patients ≥65 with diabetes, we suggest that periodic cognitive screening should be performed to identify undiagnosed cognitive impairment.
- In patients ≥65 with diabetes and a diagnosis of cognitive impairment (i.e., mild cognitive impairment or dementia), we suggest that medication regimens should be simplified, and glycemic targets tailored to improve compliance and prevent treatment-related complications.
- In patients ≥65 with diabetes, we recommend that outpatient diabetes regimens be designed specifically to minimize hypoglycemia
- In patients ≥65 with diabetes and frailty, we suggest the use of diets rich in protein and energy to prevent malnutrition and weight loss.
- In patients ≥65 with diabetes who cannot achieve glycemic targets with lifestyle modification, we suggest avoiding the use of restrictive diets and instead limiting consumption of simple sugars if patients are at risk for malnutrition
- In patients ≥65 with diabetes, we recommend metformin as the initial oral medication chosen for glycemic management in addition to lifestyle management
- In patients 65-85 with diabetes, we recommend a target blood pressure of ≤140/90 mm Hg to decrease the risk of cardiovascular disease outcomes, stroke, and progressive chronic kidney disease
- In patients ≥65 with diabetes, we suggest that if statin therapy is inadequate for reaching the LDLc reduction goal, either because of side effects or because the LDLc target is elusive, then alternative or additional approaches, such as including ezetimibe or PCSK9 inhibitor should be initiated.
- In patients ≥65 with diabetes and fasting triglycerides ≥500 mg/dL, we recommend the use of fish oil and/or fenofibrate to reduce the risk of pancreatitis
- In patients ≥65 with diabetes and congestive heart failure, the following oral hypoglycemic agents should be prescribed with caution to prevent worsening of heart failure: glinides, rosiglitazone, pioglitazone, and DDP4 inhibitors.
- In patients ≥65 with diabetes and advanced chronic sensorimotor distal polyneuropathy, we suggest treatment regimens that minimize fall risk, such as the minimized use of sedative drugs or drugs that promote orthostatic hypotension and/or hypoglycemia.
- In patients ≥65 with diabetes and peripheral neuropathy with balance and gait problems, we suggest referral to physical therapy or a fall management program to reduce the risk of fractures and fracture-related complications.