Diabetes mellitus im Alter

Diabetes mellitus ist eine der häufigsten chronischen Erkrankungen im Alter. Ältere Menschen mit Diabetes haben häufig zusätzlich funktionelle und/oder kognitive Beeinträchtigungen, die bei der Therapie berücksichtigt werden müssen. Einfache Therapieformen sollten bevorzugt werden, um eine Polypharmazie abzuwenden und die Selbstständigkeit der Patienten möglichst lange zu erhalten. Vorsorgeuntersuchungen und Behandlung diabetischer Folgeerkrankungen sind konsequent unter Beachtung alterstypischer Besonderheiten vorzunehmen.

Abstract

Diabetes is one of the most common chronical diseases in old age. More than 50 % of the patients are older than 65 years. Elderly with diabetes often suffer from functional or cognitive deficits that should be registered in therapy. These include special geriatric syndromes like memory failure, frailty, falls, immobility or higher vulnerability for drug interactions. Comorbidity und functional deficits influence each other. Simple therapy regimens should be preferred to avoid polypharmacia and to preserve patient’s independence. Specific risks of old age under new antidiabetic drugs should be noted. Check-ups and treatment of diabetic complications, especially the diabetic foot should be consequently induced considerating age-specific features.

Schlüsselwörter

Altersdiabetes - funktionelles Defizit - geriatrische Syndrome - therapeutische Ziele - Polypharmazie - neue Antidiabetika

Key words

diabetes of old age - functional deficit - geriatric syndroms - therapeutic goals - polypharmacia - new antidiabetic drugs

Publication History

Article published online:
21 July 2023

• Literatur

• 1 Holman RR, Paul SK, Bethel MA. et al. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. N Engl J Med 2008; 359: 1577-1589
• 2 Gerstein HC, Miller ME. Action to Control Cardiovascular Risk in Diabetes Study Group;. et al. Effects of Intensive Glucose Lowering in Type 2 Diabetes. N Engl J Med 2008; 358: 2545-2559
• 3 Nathan DM, Zinman B. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group;. et al. Modern-day clinical course of type 1 diabetes mellitus after 30 yearsʼ duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983–2005). Arch Intern Med 2009; 169: 1307-1316
• 4 Gaede P, Lund-Andersen H, Parving HH. et al. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Eng J Med 2008; 358: 580-591
• 5 Zimman B, Wanner C, Lachin JM. et al. Empagliflozin, cardiovascular outcomes and mortality in type 2 diabetes. N Engl J Med 2015; 373: 2117-2128
• 6 Landi F, Liperoti R, Russo A. et al. Disability, more than multimorbidity, was predictive of mortality among older persons aged 80 years and older. J Clin Epidemiol 2010; 63: 752-759
• 7 Tamayo T, Brinks R, Hoyer A. et al. The Prevalence and Incidence of Diabetes in Germany. Dtsch Arztebl Int 2016; 113: 177-182
• 8 Zeyfang A, Bahrmann A. Typ-1 Diabetes bei Älteren. In: Deutsche Diabetes Gesellschaft, Hrsg. Deutscher Gesundheitsbericht Diabetes 2022. Mainz: Kirchheim-Verlag; 2022
• 9 Zeyfang A, Wernecke J, Bahrmann A. Praxisempfehlungen: Diabetes mellitus im Alter. Diabetologie 2021; 16: 226-234
• 10 Vetrano DL, Landi F, Volpato S. et al. Association of sarcopenia with short- and long-term mortality in older adults admitted to acute care wards. Results from the CRIME study. J Gerontol A Bio Sci Med 2014; 69: 1154-1161
• 11 Flegal KM, Graubard BI, Williamson DF. et al. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293: 1861-1867
• 12 Bauer J, Biolo G, Cederholm T. et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 2013; 14: 542-559
• 13 Bahrmann A, Bahrmann P, Baumann J. et al. S2k-Leitlinie Diagnostik, Therapie und Verlaufskontrolle des Diabetes im Alter. Diabetologie 2018; 13: 423-491
• 14 Rockwood K, Song X, MacKnight C. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495
• 15 Leenders M, Verdijk LB, van der Hoeven L. et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc 2013; 14: 585-592
• 16 Bendayan M, Bibas L, Levi M. et al. Therapeutic Interventions for Frail Elderly Patients: Part II. Ongoing and Unpublished Randomized Trials. Progr Cardiovasc Dis 2014; 57: 144-151
• 17 Jacob L, Kostev K. Prevalence of depression in type 2 diabetes patients in German primary care practices. J Diabetes Complications 2016; 30: 432-437
• 18 Kimbro LB, Mangione CM, Steers WN. et al. Depression and All‐Cause Mortality in Persons with Diabetes Mellitus: Are Older Adults at Higher Risk? Results from the Translating Research Into Action for Diabetes Study. J Am Geriatr Soc 2014; 62: 2017-2022
• 19 Munshi MN. Cognitive dysfunction in older adults with diabetes: what a clinician needs to know. Diabetes Care 2017; 40: 461-467
• 20 Jackson SL, Scholes D, Boyko EJ. et al. Urinary incontinence and Diabetes in Postmenopausal Women. Diabetes Care 2005; 28: 1730-1738
• 21 Universitätsklinikum Heidelberg, Abteilung Klinische Pharmakologie und Pharmakoepidemiologie. Hilfsmittel zur Arzneimittel-Anwendung & -Sicherheit: Dosierung bei Niereninsuffizienz. Im Internet (Stand: 10.04.2023): http://www.dosing.de/nierebck.php
• 22 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.e18
• 23 Schütt K, Müller-Wiegand D, Marx N. et al. Diabetes mellitus und Herz. Diabetologie 2021; 16 (Suppl. 02) S319-S323
• 24 Yaffe K, Falvey CM, Hamilton N. et al. Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med 2013; 173: 1300-1306
• 25 Tancredi M, Rosengren A, Svensson AM. et al. Excess Mortality among Persons with Type 2 Diabetes. N Engl J Med 2015; 373: 1720-1732
• 26 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
• 27 Mone P, Lombardi A, Gambardella J. et al. Empagliflozin improves cognitive impairment in frail older adults with type 2 diabetes and heart failure with preserved ejection fraction. Diabetes Care 2022; 45: 1247-1251
• 28 Dumann E, Menne J. SGLT2-Inhibitoren: Was gibt es Neues?. Nephrologe 2021; 16: 241-255