diabetes in the elderly

^[1]^[2]^[3]^[4]

Management

if multiple comorbidities, relax glycemic control
- if insulin required, use once daily long-acting insulin
- little evidence that fingerstick monitoring benefits patients with type 2 diabetes who are not taking insulin
- hypoglycemia is a risk factor for dementia
- increased risk of dementia with insulin (12%) vs metformin^[2] or DPP4 inhibitor (RR=1.1)^[3]
also see Diabetes mellitus type-1 &/or diabetes mellitus type-2

↑ American Diabetes Association Older adults: standards of medical care in diabetes-2021 Diabetes care 2021;44(supplement_1):s168-s179 PMID: https://pubmed.ncbi.nlm.nih.gov/33298423
↑ ^2.0 ^2.1 Tucker ME One Type of Older Diabetes Drug Cuts Dementia Risk, Another Ups It. Medscape. Oct 11, 2022 https://www.medscape.com/viewarticle/982256
Tang X et al Use of oral diabetes medications and the risk of incident dementia in US veterans aged >= 60 years with type 2 diabetes. BMJ Open Diabetes Research & Care. 2022 10(5): PMID: https://pubmed.ncbi.nlm.nih.gov/36220195 PMCID: PMC9472121 Free PMC article https://drc.bmj.com/content/10/5/e002894
↑ ^3.0 ^3.1 Wu CW, Iskander C, Wang C et al Association of sulfonylureas with the risk of dementia: A population-based cohort study. J Am Geriatr Soc. 2023. Oct;71(10):3059-3070 PMID: https://pubmed.ncbi.nlm.nih.gov/37218376 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18397
↑ Araki A. Individualized treatment of diabetes mellitus in older adults. Geriatr Gerontol Int. 2024;24(12):1257-1268 PMID: https://pubmed.ncbi.nlm.nih.gov/39375857 PMCID: PMC11628902