THE aging population is unprecedented and the proportion of older persons is increasing while a decline in the younger population is observed. The diagnosis of diabetes has increased in epidemic proportions. The increase in life expectancy raises the number of older persons with diabetes being seen in the clinics. The International Diabetes Foundation (IDF) has issued a global guideline in the management of older persons with type 2 diabetes.
“The highly prevalent nature of diabetes in aging populations is characterized by the complexity of illness, an increased risk of medical co-morbidities, and the early development of functional decline and risk of frailty. When these are coupled with the common and widespread occurrence of delayed diagnosis, frequent admission to hospital, and clinical-care systems that may be suboptimal, if not inadequate, it is not surprising that the IDF now feels it is important to address these shortfalls by a guideline which lays the foundation for high-quality diabetes care for older people.”
The IDF recommended guidelines according to functional categories of the elderly. Hence, management is appropriated according to the following:
Category 1: Functionally independent. These are people who are living independently and have no impairments in their activities of daily living.
Category 2. Functionally dependent. This category represents those individuals who, due to loss of function, have impairments of ADL such as bathing, dressing, or personal care. This category includes a range of functionally dependent older people with diabetes. Two groups require special consideration:
Subcategory A : Frail. These individuals are characterized by a combination of significant fatigue, recent weight loss, severe restriction in mobility and strength, increased propensity to falls, and increased risk of institutionalization. Frailty is a recognized condition and accounts for up to 25 percent of older people with diabetes.
Subcategory B : Dementia. Individuals in this subcategory have a degree of cognitive impairment that has led to significant memory problems, a degree of disorientation, or a change in personality, and who now are unable to self-care.
Category 3. End of life care. These individuals are characterized by a significant medical illness or malignancy and have a life expectancy reduced to less than 1 year.
The IDF also recommends several assessment tools to help clinicians categorize the older persons. These categories will now help doctors in properly managing older persons with type 2 diabetes and as to the choice of drugs proper to each. It is very important then to screen the older persons for diabetes and manage accordingly. The complete guideline may be downloaded at www.IDF-Guideline-for-older-people-T2D.pdf.