Specifics of diabetes in old age

Abstract

Diabetes mellitus (DM) is a major global problem, especially as its incidence continues to increase. This is due both to the increasing life expectancy and also to the prevailing lifestyle, which is characterized by low physical activity and high-energy diets. Currently, there are over 900,000 patients with diabetes in the Czech Republic, and more than one third of these patients are in the geriatric category (1). The incidence of diabetic complications is also increasing. These are, on one hand, microvascular changes specific to diabetes mellitus (retino, neuro, nephropathy), on the other hand, diabetics are more at risk of cardiovascular diseases (ischemic heart disease, atherosclerosis of extremity arteries and cerebral vascular disease), heart failure and sudden cardiac death (2, 3, 4). In addition, often present cognitive disorders and depression complicate the situation (5, 6). In addition, memory loss and visual impairment worsen the results of DM treatment. Generally, there are two categories of geriatric patients, namely patients who are proficient, without severe comorbidities, and those who are fragile, with a significant reduction in self-sufficiency. The treatment of these two groups of patients is fundamentally different (9). While proficient patients can be treated in the same way as younger and middle-aged patients, fragile patients require a highly individualized approach favoring in particular the safety of treatment with looser goals (7, 8).