Update on Diabetes in the Elderly and in Nursing Home Residents

Alexandra Migdal, Shadi Yarandi, Dawn Smiley, Guillermo E. Umpierrez

Research output: Contribution to journalReview article

Abstract

Diabetes is common in the elderly population and in nursing home residents. More than 20% of adults aged 65 to 75 years and 40% of adults older than 80 years suffer from diabetes. Physiological changes in elderly individuals, such as decreased physical activity, abdominal obesity, and increased inflammatory state, increase insulin resistance in peripheral tissue and reduce glucose-dependent insulin release, leading to carbohydrate intolerance and diabetes. The clinical presentation in the elderly and nursing home residents is frequently guided by the high rate of comorbidities such as hypertension, depression, and cardiovascular diseases. Treatment recommendations for glycemic control in elderly ambulatory patients are similar to those in long-term care facilities. Healthy patients with diabetes should aim for near-normal fasting plasma glucose and an HbA1C of about 7%; however, treatment goals must be individualized in patients with impaired cognitive and physical ability, reduced life expectancy, and heavy burden of comorbid disease. Elderly individuals and nursing home residents are at increased risk of hypoglycemia during pharmacological treatment. In general, a conservative and stepwise approach to the treatment of the elderly patient with diabetes is suggested. Treatment may be initiated with dietary and physical activity modification and with a single oral agent, followed by a combination of oral agents and insulin therapy if needed. Evidence from clinical trials indicates that improving glycemic control, as well as cardiovascular risk factors, reduces morbidity and mortality in older individuals with diabetes.

Original languageEnglish (US)
JournalJournal of the American Medical Directors Association
Volume12
Issue number9
DOIs
StatePublished - Nov 1 2011
Externally publishedYes

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Nursing Homes
Therapeutics
Exercise
Insulin
Glucose
Aptitude
Abdominal Obesity
Long-Term Care
Life Expectancy
Hypoglycemia
Insulin Resistance
Comorbidity
Fasting
Cardiovascular Diseases
Clinical Trials
Pharmacology
Depression
Hypertension
Morbidity
Mortality

Keywords

  • Diabetes
  • Hypoglycemia
  • Insulin
  • Long-term care facilities
  • Nursing home

ASJC Scopus subject areas

  • Medicine(all)
  • Nursing(all)
  • Health Policy

Cite this

Update on Diabetes in the Elderly and in Nursing Home Residents. / Migdal, Alexandra; Yarandi, Shadi; Smiley, Dawn; Umpierrez, Guillermo E.

In: Journal of the American Medical Directors Association, Vol. 12, No. 9, 01.11.2011.

Research output: Contribution to journalReview article

Migdal, Alexandra ; Yarandi, Shadi ; Smiley, Dawn ; Umpierrez, Guillermo E. / Update on Diabetes in the Elderly and in Nursing Home Residents. In: Journal of the American Medical Directors Association. 2011 ; Vol. 12, No. 9.
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