Results
We found 176 studies and firstly check them by the ti
-
tles and abstracts to see if they were fulfilling the crite
-
ria. Only 20 that fulfilled inclusion criteria were in
-
cluded, fully reviewed and summarized in this review
article.
The elderly population is very heterogeneous, con
-
taining within itself a very large interindividual varia
-
tions. Physiological process of aging depends on both ge
-
netic and environmental factors, as well as the presence
of disease can significantly accelerate the aging process.
One should distinguish the concept of chronological (cal
-
endar) and physiological (cellular) age. Biological age es
-
timate is based on assessment of cardiovascular, respira
-
tory system as well as renal function
8
. The population of
elderly people are on one side of the
»
spectrum
«»
old
youngsters
«
with preserved physiological function and
functional capacity above expected levels for age and, on
the other hand the same
»
spectrum
«
hard empowered se-
niors (frailty syndrome), which are weak, exhausted and
dependent on the help of others
9
. The concept of popula-
tion heterogeneity in older people with diabetes is the
foundation of an individualized care for elderly diabetics.
This individualized approach involves synergism of
nonpharmacologic and pharmacologic measures. Non-
-pharmacological counseling aims for lifestyle changes
(diet, exercise, self-control), and pharmacological means
prescribing medications. When choosing medications for
elderly diabetics, one should take into account side ef-
fects of some (hypoglycemia, weight gain, fluid retention,
gastrointestinal disorders, flatulence), contraindications
or appropriate dose adjustment for individual patients
(hypoxia, congestive heart failure, renal impairment)
10
but also adjust prescription to the patient’s personal
choice, prognosis and comorbidity, always taking into ac
-
count the quality of life. In
»
biologically younger
«
elderly,
with longer life expectancy goals of glycemic control are
equal as in adults aged <65 years, and the same recom
-
mendations for nonsmoking, regular exercise, maintain
-
ing a normal BMI, target blood pressure and hyperlipi
-
demia apply
11
. But in those
»
biologically older
«
target
HbA1c is shifted towards higher proportionally with in
-
creasing age, reduced functional abilities, cognitive ca
-
pacities and ability for self-care.
The therapeutic
goals of glycemic control, blood pres
-
sure, and hyperlipidemia in elderly diabetics according to
Kirkman MS and colleagues
12
are shown in Table 1.
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