The Elderly Type 2 Diabetic Patient: Special Considerations John E. Morley*
Geriatric Research, Education and Clinical Center, St Louis VAMC, and Division of Geriatric Medicine, St Louis University Medical School, St Louis, Missouri, USA Diabetes mellitus is a common disease in older people, with almost 50 % of Type 2 diabetic patients being over 60 years of age; despite this, half of older people with frank diabetes are not diagnosed. While insulin resistance is common in older people, large numbers also have impaired insulin secretion. Age, body habitus and physical activity all play a role in the pathogenesis of hyperglycaemia associated with diabetes mellitus. Leptin levels relate to insulin resistance in older people and amylin secretion is associated with delayed return of glucose levels to baseline. Depression, impaired cognitive function, and lack of recognition of thirst and subsequent dehydration are important factors to be taken into account in the management of older diabetic patients, who may also have impaired physical function, an increased rate of injurious falls, and increased prevalence of pressure ulcers, amputations and tuberculosis. Hyperglycaemia can result in a decreased pain threshold and incontinence. Dietary management plays less of a role in older diabetic patients but exercise, with a particular emphasis on balance and stability, is an important component of the The prevalence of diabetes mellitus and impaired glucose tolerance increases with age.1 Marked variations in the prevalence of diabetes occur in older people in different countries (Figure 1) although the high prevalence of undiagnosed diabetes may explain these findings.1–5 The highest prevalence of diabetes in people aged 65–74 years is reported to be 40 % among the Pima Native Americans.2 Insufficient data are available on the preva- lence of diabetes in people over 74 years of age. In view of the premature deaths associated with diabetes and the decline in body weight and fat seen beyond the age of 75 years,7 it is possible that a decline in both the prevalence and the incidence of diabetes occurs in advanced age. In the USA, people with diabetes over the age of 55 years are more likely to be in nursing homes (18.3 %) compared with a prevalence of diabetes in the general population over 55 years of 12.6 %.8 In nursing homes, people with diabetes tend to be younger and are more likely to be Black than non-diabetic residents. Despite the fact that approximately 50 % of people;
ผู้สูงอายุชนิดที่ 2 โรคเบาหวานผู้ป่วย: ข้อควรพิจารณาพิเศษจอห์น E. Morley *Geriatric Research, Education and Clinical Center, St Louis VAMC, and Division of Geriatric Medicine, St Louis University Medical School, St Louis, Missouri, USA Diabetes mellitus is a common disease in older people, with almost 50 % of Type 2 diabetic patients being over 60 years of age; despite this, half of older people with frank diabetes are not diagnosed. While insulin resistance is common in older people, large numbers also have impaired insulin secretion. Age, body habitus and physical activity all play a role in the pathogenesis of hyperglycaemia associated with diabetes mellitus. Leptin levels relate to insulin resistance in older people and amylin secretion is associated with delayed return of glucose levels to baseline. Depression, impaired cognitive function, and lack of recognition of thirst and subsequent dehydration are important factors to be taken into account in the management of older diabetic patients, who may also have impaired physical function, an increased rate of injurious falls, and increased prevalence of pressure ulcers, amputations and tuberculosis. Hyperglycaemia can result in a decreased pain threshold and incontinence. Dietary management plays less of a role in older diabetic patients but exercise, with a particular emphasis on balance and stability, is an important component of the The prevalence of diabetes mellitus and impaired glucose tolerance increases with age.1 Marked variations in the prevalence of diabetes occur in older people in different countries (Figure 1) although the high prevalence of undiagnosed diabetes may explain these findings.1–5 The highest prevalence of diabetes in people aged 65–74 years is reported to be 40 % among the Pima Native Americans.2 Insufficient data are available on the preva- lence of diabetes in people over 74 years of age. In view of the premature deaths associated with diabetes and the decline in body weight and fat seen beyond the age of 75 years,7 it is possible that a decline in both the prevalence and the incidence of diabetes occurs in advanced age. In the USA, people with diabetes over the age of 55 years are more likely to be in nursing homes (18.3 %) compared with a prevalence of diabetes in the general population over 55 years of 12.6 %.8 In nursing homes, people with diabetes tend to be younger and are more likely to be Black than non-diabetic residents. Despite the fact that approximately 50 % of people;
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