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Regardless of the treatment goals decided, all older diabetics should receive care that meets minimum standards as shown in Table 2
The four standard modalities of diabetes treatment - diet, exercise, oral hypoglycemic agents, and insulin - all merit consideration in older diabetics also.
Pharmacological therapy of an elderly diabetic poses many problems. Drugs may be used inappropriately, when the effects of treatment may be worse than the symptoms for which it was given. Polypharmacy is a common problem, often due to the presence of multiple co-existing diseases, but sometimes drugs are prescribed by several doctors who are not individually aware of the patient's other medications, leading a host of drug interactions. Drug compliance is also poor in the elderly due to deficient memory, sight or hearing, or due to unacceptable adverse effects. Pharmacodynamics of many drugs are altered in the elderly due to many physiologic changes, increasing the propensity for drug toxicity.
Table 2: Minimum Standards of Care for Older Adults with Diabetes Mellitus
Initial Evaluation
Complete history and physical examination
Geriatric assessment (functional assessment)
Laboratory examination: fasting blood glucose, glycosylated hemoglobin, fasting lipid profile, creatinine, urinalysis, and ECG.
Ophthalmological evaluation
Dietary assessment
Continuing Care
Use of treatment as needed to meet target glucose levels
Assessment of blood glucose levels as frequently as needed to make sure that goals are being met
Annual assessment for diabetic complications
Annual review of geriatric (functional) assessment
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