Diabetes and Ageing: From Treatment Goals to Pharmacological Therapy

Diabetes Mellitus denotes a group of common metabolic disorders that share the common phenotype of hyperglycemia. It is becoming one of the most widespread health issues in all age groups. People living with diabetes have a higher risk of morbidity and mortality than the general population. As per IDF (International Diabetes Federation), the prevalence of diabetes in adults aged 20–79 years was estimated to be 8.8% in 2015 and is predicted to rise to 10.4% in 2040. As per data by ICMR- INDIAB -17, Prevalence of diabetes is 11.4%, while that of prediabetes is 15.3%. Older adults with diabetes are at an increased risk of various complications, such as cognitive decline, dementia, urinary incontinence, osteoporosis, falls, fractures, disability, and medication side effects. These issues significantly impact the quality of life and can interfere with effective diabetes management. As a result, managing type 2 diabetes in elderly patients has become a growing concern.

The American Diabetes Association recommends an HbA1c target of less than 7% for older adults who have good cognitive and functional abilities and few chronic conditions, while an HbA1c target of less than 8% is advised for those with multiple comorbidities or cognitive impairment.

Diabetes management and antihyperglycemic treatment should be personalized based on the patient's comorbidities and the duration of their diabetes. It is essential to prioritize medications that have a low risk of causing hypoglycemia. Safe antihyperglycemic options for older patients with type 2 diabetes include metformin (the first-line treatment), pioglitazone, dipeptidyl peptidase-4 inhibitors, and glucagon-like peptide-1 receptor agonists. Insulin secretagogues, such as sulfonylureas, should be used cautiously due to the increased risk of hypoglycemia. If sulfonylureas are used, short-acting versions like gliclazide or glinides like repaglinide are preferred. When insulin therapy is necessary, careful attention must be given to the risk of hypoglycemia, and tight glycemic control should not be the primary goal.