Diabetes Mellitus at an Elderly Age

Thanks to good medical care in Germany, many people with diabetes mellitus now live well into old age: Of the 340,000 adults with type 1 diabetes, more than 100,000 are over 70 years of age. Approximately 8 million people have type 2 diabetes and one-fourth of this group is over 75 years of age, and approximately 1 million over the age of 80 [8].

Nationwide, there are a total of about 630,000 people with diabetes mellitus in need of care. The statements in the clinical practice guidelines are mainly directed at the majority of elderly people with type 2 diabetes and can only reflect some of the special characteristics of elderly people with diabetes. Topics such as type 1 diabetes at an elderly age, end of life, interface management or ethics are covered in the complete S2k Guideline.

The geriatric patient is defined by multimorbidity and a higher age. Age-typical functional limitations and high vulnerability create a special need for action that goes beyond blood glucose control and the management of cardiovascular risk factors or diabetes-typical complications. For differentiated therapy planning, elderly patients should be divided into functional groups ([Tab. 1]).

Tab. 1 Classification into functional groups.

Patient group	Patient description
Functionally independent	Elderly people with diabetes mellitus and good functional status. Patients with low comorbidity, at best low cognitive impairment and good compensation possibilities
Functionally slightly dependent	Elderly people with diabetes mellitus and limited functional status. Patients with multimorbidity, functional and cognitive limitations and geriatric syndromes
Functionally highly dependent	Elderly people with diabetes mellitus and extremely limited functional status or terminally ill patients. Patients with multimorbidity, geriatric symptoms, pronounced functional and cognitive limitations and the presence of diseases with limited life prognosis, e. g. terminal heart, kidney or malignant diseases
End of life	People who are on their deathbed

A geriatric assessment should be conducted to determine resources and deficits (division into functional groups) (Practice tool 1, see Appendix).

Publikationsverlauf

Artikel online veröffentlicht:
06. Mai 2025

• References

• 1 Bahrmann A, Bahrmann P, Baumann J. et al. AWMF S2k-Leitlinie Diabetes im Alter, S2k-Leitlinie Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Alter. Diabetol Stoffwechs 2018; 13: 423-489
• 2 Wernecke J, Bahrmann A, Zeyfang A. Individuelle Therapieziele bei betagten Diabetespatienten. Diabetologe 2012; 8: 108-112
• 3 Hodeck K, Tittel SR, Dreyhaupt I. et al. Charakteristika von Diabetespatienten mit und ohne Pflegebedürftigkeit. Diabetol Stoffwechs 2020; 15: 392-399
• 4 Budnitz DS, Lovegrove MC, Shehab N. et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011; 365: 2002-2012
• 5 Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie Typ-2-Diabetes – Teilpublikation der Langfassung. 2021; 2. Auflage. Version1
• 6 Lacy ME, Gilsanz P, Eng CH. et al. Severe Hypoglycemia and Cognitive Function in Older Adults With Type 1 Diabetes: The Study of Longevity in Diabetes (SOLID). Diabetes Care 2019; 43: 541-548
• 7 Beckett NS, Peters R, Fletcher AE. for the HYVET Study Group et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887-1898
• 8 Bahrmann A, Wernecke J. Der geriatrische Patient mit diabetischem Fußsyndrom. Diabetologe 2022; 18: 225-231
• 9 Kansagara D, Fu R, Freeman M. et al. Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med 2011; 154: 268-282
• 10 Zeyfang A, Feucht I, Fetzer G. et al. Eine strukturierte geriatrische Diabetiker-Schulung (SGS) ist sinnvoll. Diabetol Stoffwechs 2001; 10: 203-207
• 11 Wehling M, Burkhardt H. Hrsg. Arzneimitteltherapie für Ältere. 5. Aufl. Heidelberg: Springer; 2019
• 12 Pfeffer MA, Claggett B, Diaz R. for the ELIXA Investigators et al. Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N Engl J Med 2015; 373: 2247-2257
• 13 Marso SP, Daniels GH, Brown-Frandsen K. for the LEADER Steering Committee on behalf of the LEADER Trial Investigators et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375: 311-322
• 14 Marso SP, Bain SC, Consoli A. for the SUSTAIN-6 Investigators et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016; 375: 1834-1844
• 15 Holman RR, Bethel A, Mentz RJ. for the EXSCEL Study Group et al. Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2017; 377: 1228-1239
• 16 Gerstein HC, Colhoun HM, Dagenais GR. et al. Dulaglutide an cardiovascular outcomes in type 2 diabetes (REWIND). Lancet 2019; 394: 121-130
• 17 Zinman B, Wanner Ch, Lachin JM. for the EMPA-REG OUTCOME Investigators et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373: 2117-2128
• 18 Perkovic V, Jardine MJ, Neal B. et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med 2019; 380: 2295-2306
• 19 Zeyfang A, Berndt S, Aurnhammer G. et al. A short easy test can detect ability for autonomous insulin injection by the elderly with diabetes mellitus. J Am Med Dir Assoc 2012; 13: 81.e15-81.e8.1E18
• 20 . McMurray JJV, Solomon SD, Inzucchi SE. et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; 381: 1995-2008
• 21 Rosenstock J, Dailey G, Massi-Benedetti M. et al. Reduced hypoglycemia risk with insulin glargine: a meta-analysis comparing insulin glargine with human NPH insulin in type 2 diabetes. Diabetes Care 2005; 28: 950-955
• 22 Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722-727
• 23 Kulzer B, Albus C, Herpertz S. et al. Psychosoziales und Diabetes – Teil 1. S2-Leitlinie Psychosoziales und Diabetes – Langfassung. Diabetol Stoffwechs 2013; 8 . 198-242 Teil 2. Diabetol Stoffwechs 8: 292-324
• 24 Cheng G, Huang C, Deng H. et al. Diabetes as a risk factor for dementia and mild cognitive im-pairment: a meta-analysis of longitudinal studies. Intern Med J 2012; 42: 484-491
• 25 Jackson SL, Scholes D, Boyko EJ. et al. Urinary incontinence and Diabetes in Postmeopausal Women. Diabetes Care 2005; 28: 1730-1738
• 26 Deutsche Gesellschaft für Kardiologie – Herz-und Kreislaufforschung e.V. Hrsg. ESC/EAS Pocket Guidelines. Diagnostik und Therapie der Dyslipidämien, Version 2019. Grünwald: Börm Bruckmeier Verlag GmbH; 2020
• 27 Mach F, Baigent C, Catapano AL. ESC Scientific Document Group et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188
• 28 Fachinformation Jardiance Böhringer Ingelheim Stand Juli 2022.
• 29 Therapie des Typ-1-Diabetes. S3-Leitlinie der Deutschen Diabetes Gesellschaft (DDG). Version 5.0. AWMF-Registernummer: 057-013. 2023
• 30 Baek HS, Jeong C, Yang Y. et al. Diabetic Ketoacidosis as an Effect of Sodium-Glucose Cotransporter 2 Inhibitor: Real World Insights. Diabetes Metab J 2024; 48: 1169-1175