Management of Diabetes Mellitus in the Elderly

Abstract

Introduction: Due to increasing life expectancy and lifestyle changes, the prevalence of diabetes among the elderly is rising, along with the associated public health burden. Diabetes management in this population is complicated by age-related physiological changes, sarcopenia, comorbidities, and varying degrees of functional and cognitive abilities that contribute to frailty.

Methods: This narrative review examines the unique characteristics and complex challenges of managing diabetes in the elderly. It synthesizes recent literature and clinical guidelines to recommend a comprehensive yet personalized management strategy that accounts for the heterogeneity of this patient group.

Results: Elderly patients with diabetes often face multiple chronic conditions that increase their risk of cardiovascular disease, cancer, and mortality. They are also more vulnerable to severe acute complications such as hyperosmolar hyperglycemic state and hypoglycemia. Optimal management involves a holistic assessment of functional and cognitive status, nutritional state, and the presence of geriatric syndromes. This assessment guides the individualization of glycemic targets, which are often less stringent than in younger adults. Therapeutic choices should prioritize agents with a low risk of hypoglycemia and consider the patient's comorbidities, polypharmacy, and overall quality of life.

Conclusions: A personalized, patient-centered approach is essential to reduce morbidity and mortality in geriatric patients with diabetes. Optimal management, which includes ongoing education, regular screening for complications and geriatric syndromes, and multidisciplinary supervision, is critical for maintaining functional independence and improving health outcomes