Type 2 diabetes in patients older than 70 years — aspects of metabolic control

Abstract

Background. The differences in the clinical manifesta­tion and course of diabetes observed in older individu­als should translate into various options of treatment and management of the elderly diabetic patients. Of particular importance is the early detection of disease complications due to its impact on the physical and mental health of elderly patients. Material and methods. All participants were hospital­ised in the Department of Internal Medicine, University Hospital No. 1 between the year 2012–2016. Based on the medical records, the consecutively presenting patients diagnosed with type 2 diabetes were divided into three basic groups: group 1 aged 37–58 years (30 individuals), group 2 aged 70–79 years (30 individu­als) and group 3 aged ≥ 80 years (50 individuals). The exclusion criteria were lack of logical verbal contact and substantial impairment of physical activity verified with the Katz Basic Activities of Daily Living (ADL) scale. Based on the medical history and documentation, the duration of diabetes, the BMI and frequency of hypo­glycaemia were established. Among patients, as part of their stay and regardless of the study conducted, the main parameters were determined referring to metabolic control of type 2 diabetes mellitus (percent­age of glycated haemoglobin, lipid profile) and blood pressure measurement. Results. The particular groups of patients differed in terms of the mean disease duration (p < 0.001), i.e. 5 ± 6.4 years in group 1, 16.1 ± 8.6 years in group 2 and 14.6 ± 9 years in group 3. There were statisti­cally significant inter-group differences in mean body weight (BW) and BMI (patients ≥ 80: BW — 70.7 ± 14.3 (kg), BMI: 27.5 ± 4.3 (kg/m2); 70–79 years of age group: BW: 77.1 ± 16.4 (kg), BMI: 28.9 ± 6 (kg/m2); group 1 (BW: 92.4 ± 21.4 (kg), BMI: 31.5 ± 7.0 (kg/m2). The best glucose control was observed amongst patients ≥ 80 (group 3), as compared to group 1 — 47 patients (84%) vs. 4 patients (13.3%) (p < 0.001). The percent­ages of HbA 1c were as follows: 8.7 ± 2.3 (%) in group 1, 7.3 ± 1.2 (%) in group 2 and 6.9 ± 0.9 in group 3, respectively (p < 0.001). There were no statistically significant differences in the blood pressure between particular groups of patients. Hypoglycaemia did not occur more frequently in any of the studied groups. Conclusions. Elderly patients suffering from type 2 diabetes vary in numerous aspects from younger patients. The basic differences were observed in rela­tion to anthropometric indices and average duration of the disease. Treatment of type 2 diabetes in elderly patients leads to excessive control with respect to the carbohydrate metabolism although patients do not report hypoglycaemia more frequently.