Older patients and type 2 diabetes

Type 2 diabetes is common in older people, and leads to higher rates of premature death, functional disability, accelerated muscle loss and concurrent illness (eg elevated blood pressure, cardiovascular disease, stroke).

Management of older patients with type 2 diabetes must be individualised. Ageing is a continuum encompassing patients who are otherwise well, functionally independent and probably have further years of a healthy life expectancy, through to patients with functional dependence, frailty, dementia and limited life expectancy.

Decisions regarding treatment of older patients with type 2 diabetes should be based on the patient’s age, life expectancy and their functional status. Particular issues for older patients with diabetes include:

  • complications of diabetes causing functional impairment such as impaired vision, dexterity and/or mobility
  • possible reduced nutritional status or need for enteral feeding
  • frailty
  • social isolation (living alone)
  • cognitive impairment
  • depression
  • increased risk of falls
  • comorbidities and the consequent need for polypharmacy, leading to greater risk of drug interactions.

These conditions can affect the patient’s ability to self-manage their diabetes as well as affecting their general functional status.

For older patients with type 2 diabetes, recommended glycated haemoglobin (HbA1c) targets should be individualised based on their clinical situation; targets are listed in Glycaemic targets for adults with type 2 diabetes. Hypoglycaemia should be avoided and insulin regimens to lower blood glucose concentrations should be simplified. See also Rationalising antihyperglycaemic drugs in palliative care for information about glycaemic targets and care of patients with diabetes at the end of life.

Management of diabetes in residential aged care facilities requires effective communication (including documentation and planning) between the patient’s treating clinician and the care facility. Staff in the facility should be trained in management of patients with diabetes. They should be aware of the different requirements, as well as similarities, of type 1 and type 2 diabetes. A practical handbook for the management of diabetes in aged care is available from the National Diabetes Services Scheme (NDSS) website.

If uncertain about how to proceed with management at any stage, contact the local multidisciplinary diabetes team for advice.