An endocrinologist reviewed a crucial chapter in the latest position statement by the Francophone Diabetes Society at a recent conference.
TOULOUSE, FRANCE — The management of patients over the age of 75 years with diabetes is discussed in a crucial chapter in the latest position statement from the Francophone Diabetes Society . The chapter reviews screening for geriatric complications, adjustment of glycemic targets, and new cardio- and nephroprotective treatments.
The international recommendations from Advanced Technologies and Treatments for Diabetes that the SFD has adopted have set individualized targets based on patients' clinical presentation, according to the percentage of time spent in each glycemic range. Theor those at high cardiovascular risk are a time spent in the target range greater than 50%, a time spent above the target range less than 50% between 180 and 250 mg/dL, and less than 10% beyond 250 mg/dL.
As for insulin therapy, it generally starts with low-dose basal insulin with education on self-monitoring of blood glucose. Continuous glucose monitoring can be useful in this context. Regarding the types of insulin used, slow analogs are preferred, and U100 glargine is often favored. Other slow analogs can be adapted according to the patient's glycemic profile, such as extended-action insulins like U300 glargine, U100 and U200 degludec, or shorter-action ones like detemir.
If the patient is frail, then the therapeutic strategy starts with metformin, followed by a DPP-4 inhibitor. These well-tolerated molecules do not cause hypoglycemia. Prescribing a GLP-1 RA in frail patients requires particular vigilance. In the presence of chronic kidney disease or heart failure, adding an SGLT2 inhibitor can provide rapid benefits. If glycemic control remains insufficient, basal insulin therapy can be instituted as a last resort.
Diabetes Mellitus Type Ii Type 2 Diabetes Type 2 DM T2DM T2D Geriatrics Elder Care Geriatric Medicine Older Adults Seniors Senior Citizens Elderly Elderly/Concerns Of Older Adults Elderly Hypoglycemia Malnutrition Nutritional Deficiency Renal Failure Renal Insufficiency Kidney Insufficiency Kidney Failure Renal Impairment
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