Typ-2-Diabetes im Alter: Beispiel für eine Patienten-zentrierte medikamentöse Therapie

Abstract

Diabetes in older adults has a high prevalence and is frequently associated with comorbidities of the cardiovascular system, dysfunction of cognition as well as depression and impaired mobility or increased frailty. Furthermore, impaired renal function, heart failure, risk for hypoglycemia and polypharmacy has to be considered in the decision about the diabetes treatment strategy. The goal of blood glucose management is driven by patient relevant issues and patient self-esteem, quality of life defined by the patient, preservation of physical and social mobility rather than potential long-term effects on reduction of cardio- and microvascular events in the future, which is limited by patient-inherent reduced life expectancy of the aged individual. Therefore, long-term diabetes medication should avoid hypoglycemia and prevent acute hyperglycemia or short-term complications on morbidity and clinical course of geriatric syndromes associated with regular blood glucose levels above 200 mg/dl (11.1 mmol/l). The therapy should be safe, easy to handle for the patient and possibly affect co-morbidities positively. However, there are limited data available about efficacy, safety and pharmacokinetics of drugs in patients over 75 years of age or older. Since more than 5 % of the population in Germany is older than 80 years means that more than 1 million of these individuals suffer from diabetes. It is time to ask for data in these elderly subpopulations by policy makers in health care.

Im Alter wird die Prognose des Typ-2-Diabetes nicht so sehr durch die Qualität der Stoffwechseleinstellung bestimmt, sondern vielmehr durch die verbleibende Lebenszeit und vor allem durch die Funktionalität des Patienten. Wichtig ist es daher, Komorbiditäten zu berücksichtigen und kurzfristige Komplikationen (z. B. eine Hypoglykämie) strikt zu vermeiden. Die Diabetestherapie sollte primär die persönlichen Lebensziele des Patienten im Fokus haben, seine Lebensqualität sowie den Erhalt der funktionellen Unabhängigkeit.

Schlüsselwörter

Demenz - Hypoglykämie - Patientenrelevanz - Typ-2-Diabetes - Alter

Key words

dementia - hypoglycemia - patient relevance - type 2 diabetes - age

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