Geriatrische Aspekte des Diabetes

Kernaussagen

• Angepasst an das individuelle Patientenrisikoprofil sollte der Leitsatz der Geriatrie: „Start low and go slow – but go far enough“ praktiziert werden. Mit diesem Therapieansatz und dem ärztlichen Mut zur Vereinfachung komplexer Therapieverfahren sowie Priorisierung einer moderaten Stoffwechselkontrolle, lassen sich die meisten Komplikationen vermeiden bzw. rechtzeitig reduzieren.

• Die sichere Handhabbarkeit der Therapie im Alltag, die Berücksichtigung möglicher Einschränkungen durch alterstypische Multimorbidität und die Vermeidung von Hypoglykämien dienen dem übergeordneten Ziel der Erhalt der Lebensqualität im Alter.

• Literatur

• 1 Heidemann C, Du Y, Schubert I et al. Prevalence and temporal trend of known diabetes mellitus: results of the German Health Interview and Examination Survey for Adults (DEGS₁). Bundesgesundheitsbl Gesundheitsfor Gesundheitssch 2013; 56: 668-677
• 2 Rathmann W, Haastert B, Icks A et al. High prevalence of undiagnosed diabetes mellitus in Southern Germany: Target populations for efficient screening. The KORA survey 2000. Diabetologia 2003; 46: 182-189
• 3 Nikolaus T, Kruse W, Bach M et al. Elderly patientsʼ problems with medication. An inhospital and follow-up study. Eur J Clin Pharmacol 1996; 49: 255-259
• 4 Bach M. Arbeitsgruppe Geriatrisches Assessment Hrsg. (Red.). Geriatrisches Basisassessment, Handlungsanleitung für die Praxis.
• 5 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
• 6 Dale A, Vatten LJ, Nilsen TI et al. Secular decline in mortality from coronary heart disease in adults with diabetes mellitus: cohort study. BMJ 2008; 337: a236-a236
• 7 Zeyfang A. Structured educational programs for geriatric patients with diabetes mellitus. MMW Fortschr Med 2005; 147: 45-46
• 8 Rizzo MR, Paolisso G et al. Relationships Between Daily Acute Glucose Fluctuations and Cognitive Performance Among Aged Type 2 Diabetic Patients. Diabetes CARE 2010; 33: 2169-2174
• 9 Bruce DG, Davis WA, Casey GP et al. Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study. Diabetologia 2009; 52: 1808-1815
• 10 Whitmer RA, Karter AJ, Yaffe K et al. Hypoglycemic episodes and risk of dementia in older patients with type2 diabetes mellitus. JAMA 2009; 301: 1565-1572
• 11 Crane PK et al. Glucose Levels and Risk of Dementia. N Engl J Med 2013; 369: 540-548
• 12 Holman RR, Paul SK, Bethel MA et al. 10-year fallow-up of intensive glucose control in type2 diabetes. N Engl J Med 2008; 359: 1577-1589
• 13 Garber A, Duncan TG, Goodman AM et al. Efficacy of metformin in typeII diabetes: results of a double-blind, placebo-controlled, dose response trial. Am J Med 1997; 103: 491-497
• 14 Scirica BM, Itamar R et al. Saxagliptin and Cardiovascular Outcomes in Patients with Type 2 Diabetes mellitus. N Engl J Med 2013; 369: 1317-1326
• 15 White WB et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 2013; 369: 1327-1335
• 16 Bailey CJ et al. Effect of dapagliflozin in patients with type 2 diabetes who have inadequate glycaemic control with metformin: a randomised, double-blind, placebo-controlled trial. Lancet 2010; 375: 2223-2233
• 17 Roumie CL, Hung AM et al. Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: a cohort study. Ann Intern Med 2012; 157: 601-610
• 18 Yki-Järvinen H. Drug Therapy Thiazolidinediones. N Engl J Med 2004; 351: 1106-1118
• 19 Nauck MA, Duran S, Kim D et al. A comparsion of twice daily exenatide and biphasic insulin aspart in patients with type2 diabetes who were suboptimally controlled with sulfonylurea and metformin: a non-inferiority study. Diabetologia 2007; 50: 259-267
• 20 The ACCORD Study Group (Action to Control Cardiovascular Risk in Diabetes Study Group). Effects of intensive glucose lowering in type2 diabetes. N Engl J Med 2008; 358: 2545-2559
• 21 The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type2 diabetes. N Engl J Med 2008; 358: 2560-2572
• 22 Duckworth W, Abraira C, Moritz T et al. Glucose control and vascular complications in veterans with type2 diabetes. N Engl J Med 2009; 360: 129-139
• 23 Jehle PM, Micheler C, Jehle DR et al. Inadequate suspension of neutral protamine hagendorn (NPH) insulin in pens. Lancet 1999; 354: 1604-1607