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Assessing Patient Functionality Is Key When Treating Seniors

Deborah J. Neveleff

December 2009
Diabetes Strategy

Age is a risk factor for type 2 diabetes. As pancreatic beta cells become impaired, insulin production decreases with age, while insulin resistance increases as the body loses lean tissue and accumulates body fat. Also, diabetes is associated with or increases the effect of age-related syndromes such as cognitive impairment, depression, pain, urinary incontinence, and injurious falls.

“Diabetes itself can be debilitating if poorly controlled, and furthermore can lead to dangerous macrovascular and microvascular complications,” says Samuel Durso, MD, MBA, AGSF, associate professor of medicine and interim director of the Division of Geriatric Medicine and Gerontology at Johns Hopkins Bayview Medical Center in Baltimore. “Thus, physicians should be alert for the presence of undiagnosed diabetes in their older populations.” A former member of the American Geriatrics Society (AGS) Panel on Improving Care for Elders with Diabetes, Durso co-wrote the 2003 AGS Guidelines for Improving the Care of Older Persons with Diabetes Mellitus.

A Need to Screen
“If diabetes goes untreated, older adults can develop fluid and electrolyte abnormalities, and can become easily dehydrated in part due to an impaired thirst mechanism,” says Mary T. Korytkowski, MD, professor of medicine in the Division of Endocrinology and Metabolism at the University of Pittsburgh Medical Center. Korytkowski served on the American Diabetes Association’s (ADA) professional practice committee that developed the 2009 Position Statement on Standards of Care in Diabetes, which includes a section on older adults.

“Persistent high blood sugar levels can also be associated with alterations in cognition,” Korytkowski adds. “Finally, older adults with diabetes are at risk for complications such as vision changes and impaired sensation due to neuropathy that can affect the ability to perform activities of daily living.”

While there are no formal screening recommendations for diabetes in older adults, blood ....

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