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The American Geriatrics Society has developed an understandable set of guidelines for improving the care of elderly loved ones with diabetes.
To learn more, review the Summary of Guidelines below and be sure to talk with your loved one’s doctors. By becoming as informed as possible, you can ensure a high quality of life for your family member and a peace of mind you will both enjoy.
Read original guidelines document (PDF)
Summary of Guidelines
1. Unless there are special circumstances where it could be harmful, 81 to 325 mg of aspirin per day is recommended for older adults to lower the risk of stroke and heart attack.
Clinical studies have shown that aspirin use can reduce the risk of heart attack and other heart disease in older adults with diabetes. The aspirin dose in these studies ranged from 75 mg. to 325 mg.
2. Older people with diabetes who have high LDL cholesterol should be given diet and exercise changes or put on cholesterol-lowering medication.
Several studies have shown that lowering LDL cholesterol reduces the risk of heart attack and stroke in older people with diabetes. Older adults with normal or nearly normal LDL cholesterol and low HDL or elevated triglycerides should be offered medicine in addition to nutrition education. Nutrition education, increased exercise, and weight loss also improve cardiovascular health in older adults with diabetes.
3. High blood pressure should be treated gradually to avoid complications, with a target blood pressure of less than 130/80 mm Hg if it is tolerated.
There is strong evidence from a number of clinical studies that drug therapy for blood pressure management reduces death from heart attack and stroke in middle-aged and older people. Because older adults may have less tolerance for blood pressure reduction, it should be treated gradually to avoid complications.
4. The blood glucose A1c target should be individualized. The American Diabetes Association target of 7% or less is a reasonable goal for relatively healthy adults who function well. 8% is a more realistic goal for frail older adults and others in whom the risks of tight blood glucose control outweigh the benefits.
Clinical studies of people in late middle age with type 2 diabetes found that a 1% reduction in A1c was associated with a 37% drop in small blood vessel complications and a 21% drop in the risk of other diabetes-related complications. Therefore, older adults who are in reasonably good health, or those who already have some small blood vessel damage can benefit from tight blood sugar control.
Frail older adults are at higher risk for serious low blood sugar (hypoglycemia), so if they take certain medications, they may need to check their blood glucose more often. Their doctor will take the hypoglycemia risk into account when setting their A1c target.
5. Encourage the person and caregivers to receive diabetes education and make them aware that it is a covered benefit under Medicare.
Studies show that education on medication use, blood glucose monitoring, and recognizing high and low blood sugar can greatly improve a person’s blood glucose control.
For many people, especially those with diabetes complications, one-on-one counseling or group classes with a diabetes educator can improve diabetes control. Yearly diabetes self management training is a covered benefit under Medicare Part B (http://www.medicare.gov)
6. Older people should have regular eye exams, foot exams, and tests of kidney functioning.
Studies show that early diagnosis and treatment of diabetic retinopathy2 reduces the risk of blindness.
All people with diabetes should have a foot examination at least once a year. Regular foot exams allow early diagnosis of diabetic neuropathy3 and injuries which might turn into ulcers and lead to amputation.
A test for the presence of microalbumin4 in the urine should be done at the time of diagnosis in people with type 2 diabetes, and once a year afterward. Kidney disease can be avoided or its progress slowed by keeping your loved one’s blood glucose at normal levels and treating their high blood pressure, if applicable.
7. People who smoke should be helped with counseling and medications to quit smoking.
Among people with diabetes, smokers have a higher risk than nonsmokers of premature death from heart disease. The good news: in just 2 to 3 years after quitting smoking, the risk of coronary heart disease falls to levels similar to those of people who never smoked.
8. Screen and treat for the following age-related conditions that are more common in older people with diabetes: depression, harmful falls, urinary incontinence, forgetfulness and other mental problems, and persistent pain.
Older people with diabetes have a higher risk of depression. Family doctors have a number of routine screening surveys that can help them to judge if a patient is depressed.
Older people with diabetes have a higher risk of falling and seriously hurting themselves. Diabetes-related causes include physical disability, vision problems, nerve damage in the feet and legs, low blood sugar, or drug interactions and side effects.
Older women with diabetes are at higher risk for urinary incontinence than men. It may be due to high blood sugar, but many other health problems can also lead to loss of urine control, so ask the family doctor to test for the cause.
Failing memory and other losses of mental ability make it harder for the older person to check their blood sugar, feed themselves properly and remember to take their meds on schedule.
Older adults with diabetes can experience pain from nerve damage, and those with pain are often under-treated.
9. Older people with diabetes should be evaluated at each doctor visit for drug side effects and drug interactions.
Older adults with diabetes are at high risk for drug side effects and drug interactions, because they may take several drugs each day to manage blood sugar, cholesterol, blood pressure, and other conditions. The doctor should review every prescription and over-the-counter drug, ointment, and supplement being used by the patient at every visit and check that the person is taking each medicine properly.
Examples of adverse drug reactions in diabetes care:
People with poor kidney function should not use metformin because of the increased risk of lactic acidosis, a rare but serious complication.
The diabetes pill chlorpropamide lasts a very long time in the body, particularly in older adults. It is associated with increased risk for low blood sugar, and this risk increases with age.
Some high blood pressure medications such as ACE inhibitors can cause kidney failure as a side effect, so it is important to check kidney function 1-2 weeks after starting the meds, with each dose increase afterward, and at least once per year.