Treating diabetes in the very old: an intersocietary consensus document

Abstract

In the oldest old diabetes mellitus (DM) qualifies as a difficult to treat condition due to the impact of multimorbidity, the risk of adverse drug reactions and drug-drug interaction, sensory impairment and other causes of complexity. Thus, a thorough multidomain assessment is mandatory to have a comprehensive view of the patient’s health status and to define a hierarchy of needs as well as to tailor the path of care. Accordingly, the philosophy and the practical implementation of comprehensive geriatric assessment should be shared among general practitioner and different specialists caring for the older diabetic patient, and a multidisciplinary approach is desirable for difficult to manage conditions. Special attention should be paid to frequently overlooked threats such as drug-drug interactions, cognitive deficits potentially limiting the adherence to the therapy, destabilizing events such as major surgery. In this monograph, the main areas of interest for an optimal pharmacological and non pharmacological treatment of the oldest diabetic patient are discussed by a multispecialistic team. While individual sections have individual authors, all of them have been jointly revised by the full panel of authors and a truly shared version has been achieved. This guarantees for the present text representing an integrated multicultural approach to a topic of primary importance in Geriatrics.