Diabetes Mellitus
The prevalence of diabetes is increasing across the world, not only in more economically developed countries, and diabetes is one of the most significant chronic diseases. More than 90% of all patients with diabetes disclose type 2 diabetes or non-insulin
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Relevance for Elderly Patients, Epidemiology
Therapeutically Relevant Special Features of Elderly Patients
The prevalence of diabetes is increasing across the world, not only in more economically developed countries, and diabetes is one of the most significant chronic diseases. More than 90% of all patients with diabetes disclose type 2 diabetes or non-insulin-dependent diabetes, which is associated with the metabolic syndrome and a sedentary lifestyle. Epidemiologic studies and surveys consistently show an increase of the prevalence with advancing age (Fig. 1). Diabetes is a major cause for reduced life expectancy and aggravated morbidity. This is due to both vascular complications and loss of metabolic control, leading to hyper- or hypoglycemia. As far as morbidity is concerned, this includes reduced functional capacities in daily activities, loss of independence in everyday life, and reduced quality of life. Last but not least, this poses enormous costs on society. Estimations from economic surveys in Western countries found up to 17% of global health insurance budget spent for the treatment of diabetes and its complications.
Patients with diabetes represent a heterogeneous population not only according to the subtype of disease, with insulin resistance or b-cytotropic deficiency as dominant causes. There are further issues triggering therapeutic decisions, with duration of disease and presence of vascular complications the leading ones. In case of type II diabetes, a longer duration of disease is usually accompanied by advancing insulin resistance and decline of b-cytotropic activity, which in turn trigger therapeutic decisions. For instance, the ADA (American Diabetes Association) clearly states that in case of advanced vascular complications, strict metabolic control has to be questioned as a primary therapeutic goal (American Diabetes Association 2009). This is particularly true for the elderly as further limiting characteristics influencing therapeutic decisions may frequently exist. These are remaining life expectancy, comorbidity, geriatric syndromes, and self-care competence. However, those characteristics are often overlooked in textbooks or general treatment recommendations, despite the fact that in real life they are the most significant patient characteristics. All together, these factors form a complex and dynamic interplay and determine individual treatment decisions (Fig. 2). The especially heterogeneous population of elderly patients with diabetes has to be treated by a highly individualized approach.
H. Burkhardt (*) IVth Department of Medicine, Geriatrics, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany e-mail: [email protected]
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_10, # Springer-Verlag Wien 2013
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Fig. 1 Age-related prevalence of diabetes in different population-based studies in the United States (US), Germany (D), and Brazil (BRA)
Fig. 2 Interference of different aspects influen
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