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Part of the book series: Current Status of Modern Therapy ((TCSMT,volume 3))

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Abstract

The complexities in management of diabetes in the elderly present a 2-fold challenge; firstly the condition itself lacks precise definition, and secondly the total care required involves considerations which extend far beyond pure metabolic control. Thus while the same general principles of treatment apply to diabetics of all ages, in the elderly the approach and priorities are somewhat changed. The main aim of therapy is the relief of symptoms of hyperglycaemia and the maintenance of a sense of wellbeing. The goal should be to achieve a degree of diabetic control that is acceptable to both patient and physician through an approach built around the patient’s established pattern of living. Emphasis should be placed more on the overall welfare of the person and less on the metabolic disorder. Whether or not complications are preventable 15 years hence by excellent control is of secondary importance in a person who develops diabetes at the age of 65.

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References

  1. Tattersall, R. B. and Fajans, S. S. (1975). A difference between the inheritance of classical juvenile-onset and maturity-onset type diabetes of young people. Diabetes, 24, 44

    Article  PubMed  CAS  Google Scholar 

  2. Cudworth, A. G. (1976). The aetiology of diabetes. Br. J. Hosp. Med, 16, 207

    Google Scholar 

  3. Pyke, D. A. (1968). The incidence and prevalence of diabetes. In W. G. Oakley, D. A. Pyke and K. W. Taylor (eds.) Clinical Diabetes and its Biochemical Basis, pp. 181–197. ( Oxford: Blackwell Scientific Publications )

    Google Scholar 

  4. Butterfield, W. J. H. (1964). Summary of the results of the Bedford Diabetes Survey. Proc. R. Soc. Med, 57, 196

    PubMed  CAS  Google Scholar 

  5. US Department of Health, Education and Welfare (1964). Glucose tolerance of adults: US 1960–62. National Center for Health Statistics, Series 11, No. 2

    Google Scholar 

  6. Oakley, W. G., Pyke, D. A. and Taylor K. W. (1978). Diabetes and Its Management. 3rd ed., p. 28 ( Oxford: Blackwell Scientific Publications )

    Google Scholar 

  7. O’Sullivan, J. B. (1974). Age gradient in blood glucose levels. Magnitude and clinical implications. Diabetes, 23, 713

    PubMed  Google Scholar 

  8. Denham, M. J. (1972). The value of random blood glucose determinations as a screening method for detecting diabetes mellitus in the elderly patients. Age Ageing, 1, 55

    Article  Google Scholar 

  9. Fitzgerald, M. G. and Keen, H. (1964). Diagnostic classification of diabetes. Br. Med. J, 1, 1568

    Article  Google Scholar 

  10. Royal College of General Practioners (1970). Five-year follow-up report on the Birmingham diabetes survey of 1962. Br. Med. J, 3, 301

    Article  Google Scholar 

  11. Fajans, S. S. (1969). The diagnosis of diabetes. Gen. Pract, 39, 149

    Google Scholar 

  12. Siperstein, M. D. (1975). The glucose tolerance test. Adv. Intern. Med, 20, 297

    PubMed  CAS  Google Scholar 

  13. Andres, R. and Tobin, J. D. (1975). Ageing and the disposition of glucose. Adv. Exp. Med. Biol, 61, 239

    Article  PubMed  CAS  Google Scholar 

  14. Chesrow, E. J. and Bleyer, J. M. (1954). The glucose tolerance test in the aged. Geriatrics, 15, 315

    Google Scholar 

  15. West, K. M., Wulf, J. A, Reigel, D. G. and Fitzgerald, D. T. (1964). Oral carbohydrate tolerance tests. Arch. Intern. Med, 113, 641

    Article  PubMed  CAS  Google Scholar 

  16. Gottfried, S. P., Plez, K. S. and Clifford, R. C. (1961). Carbohydrate metabolism in healthy old men and women over 70 years of age. Am. J. Med. Sci, 242, 475

    Article  PubMed  CAS  Google Scholar 

  17. Streeten, D. H. P., Gerstein, M. M., Marmor, B. M. and Doisy, R. J. (1965). Reduced glucose tolerance in elderly human subjects. Diabetes, 14, 579

    PubMed  CAS  Google Scholar 

  18. Beck, H., Job, D. and Sebban, C. (1973). ReproductibilitĂ© de la mesure de la glycere chez le sujet Ă¢ge. Gerontol. Clin 15, 37

    Article  CAS  Google Scholar 

  19. Williams, T. F. (1978). Diabetes mellitus in the aged. In R. B. Greenblatt (éd.). Geriatric Endocrinology. Ageing, 5, pp. 103–113 ( New York: Raven Press )

    Google Scholar 

  20. Birmingham Diabetes Survey Working Party (1976). Ten-year follow-up report on Birmingham Diabetes Survey of 1961. Br. Med. J, 2, 35

    Article  Google Scholar 

  21. Tobin, J. D., Sherwin, R. S., Liljenquist, J. E., Insel, P. A. and Andres, R. (1972). Proceedings of the Ninth International Congress of Gerontology, vol. 3, p. 155. ( Kiev: USSR )

    Google Scholar 

  22. Smith M. J. and Hall, M. R. P. (1973). Carbohydrate tolerance in the very aged. Diabetologica, 9, 387

    Article  CAS  Google Scholar 

  23. Pozefsky, T., Cocker, J. L., Langs, H. M. and Andres, R. (1965). The cortisone- glucose tolerance test: The influence of age on performance, Ann. Intern. Med, 63, 988

    PubMed  CAS  Google Scholar 

  24. Streeten, D. H. P., Gerstein, M. M., Marmor, B. M. and Doisy, R. J. (1965). Reduced glucose tolerance in elderly human subjects. Diabetes, 14, 579

    PubMed  CAS  Google Scholar 

  25. Judd, S. L., O’Leary, E., Read, P. and Fox, C. (1976). The changing role of nurses in the management of diabetes. Br. J. Hosp. Med, 16, 251

    Google Scholar 

  26. Report of the National Commission on Diabetes to the Congress of the United States, 10 December 1975: Long range plan to combat diabetes (1975). Diabetes Forecast, 28, (Suppl. 1), 1

    Google Scholar 

  27. Thorn, P. A. and Russell, R. G. (1973). Diabetic clinics today and tomorrow, mini-clinics in general practice. Br. J. Hosp. Med, 16, 251

    Google Scholar 

  28. Ruben, L. A. (1976). Diabetes and the general practitioner. Br. J. Hosp. Med, 16, 241

    Google Scholar 

  29. Burkitt, P. D. and Trowell, H. C. (1975). Refined Carbohydrate Foods and Disease; Some Implications of Dietary Fibre. ( New York: Academic Press )

    Google Scholar 

  30. Report of a Joint Working Party of the Royal College of Physicians of London and the British Cardiac Society (1976). Prevention of Coronary Heart Disease. J. R. Coll. Physicians, 10, 2

    Google Scholar 

  31. Tunbridge, R. and Weatherill, J. H. (1970). Reliability and cost of diabetic diets. Br. Med. J, 2, 78

    Article  PubMed  CAS  Google Scholar 

  32. West, K. W. (1973). Diet therapy of diabetes: an analysis of failure. Ann. Intern. Med, 79, 425

    PubMed  CAS  Google Scholar 

  33. Tomkins, A. M. and Bloom, A. (1972). Assessment of the need for continued oral therapy in diabetes. Br. Med. J, i, 649

    Article  Google Scholar 

  34. Cahill, G. F., Etzweiler, D. D. and Freinkel, N. (1976). Control and diabetes: Editorial. N. Engl. J. Med, 294, 1004

    Article  PubMed  Google Scholar 

  35. University Group Diabetes Program (1970). A study of the effects of hypogly- caemic agents on vascular complications in patients with adult-onset diabetes. Diabetes, 19, (Suppl. 2), 747

    Google Scholar 

  36. University Group Diabetics Program (1971). Effects of hypoglycaemic agents on vascular complications in patients with adult-onset diabetes III. Clinical implications of UGDP results. J. Am. Med. Assoc, 218, 1400

    Article  Google Scholar 

  37. University Group Diabetes Program (1975). A study of the effects of hypoglycaemic agents on vascular complications in patients with adult-onset diabetes V. Evaluation of phenformin therapy. Diabetes, 24 (Suppl. 1), 65

    Google Scholar 

  38. Keen, H. and Jarrett, R. J. (1970). In R. J. Jones (ed.). Second Symposium on Atherosclerosis, p. 435 ( New York: Springer-Verlag )

    Google Scholar 

  39. Paasikivi, J. (1970). Long term tolbutamide treatment after myocardial infarction. A clinical and biochemical study of 178 patients without overt diabetes. Acta Med. Scand, 507 (Suppl.), 3

    Google Scholar 

  40. Keen, H., Jarrett, R. J., Chlouverakis, C. and Boyns, D. R. (1968). The effect of treatment of moderate hypoglycaemia on the incidence of arterial disease. Postgrad. Med. J, 44, 960

    Article  Google Scholar 

  41. Boyle, D., Bhatia, S. K., Hadden, D. R, Montgomery, D. A. D. and Weaver, J. A. (1972). Ischaemic heart disease in diabetics. A prospective study. Lancet, i, 338

    Article  Google Scholar 

  42. Janbon, M., Chaptal, J., Vedel, A. and Schaap, J. (1942). Accidents hypogly- cemiques graves par un sulfamidothiazol (le VK 57 ou 2254 RP). Montpellier Med, 21–22, 441

    Google Scholar 

  43. Sonksen, P. H. and West T. E. T. (1978). Carbohydrate metabolism and diabetes mellitus. In J. L. H. O’Riordan (ed.). Recent Advances in Endocrinology and Metabolism, pp. 161–186. ( Edinburgh: Churchill Livingstone )

    Google Scholar 

  44. Hecht, A., Gershberg, H. and Hulse, M. (1973). Effect of chlorpropamide treatment on insulin secretion in diabetics: its relationship to the hypoglycaemic effect. Metabolism, 22, 723

    Article  PubMed  CAS  Google Scholar 

  45. Barnes, A. J., Garbien, K. J. T., Crowley, M. F. and Bloom, A. (1974). Effect of short and long-term chlorpropamide treatment on insulin release and blood glucose. Lancet, ii, 69

    Article  Google Scholar 

  46. Perkins, J. R., Hay, B. J., Judd, S. L., Quine, K. H., West, T. E. T. and Sonksen, P. H. (1975). Effect of diet, sulphonylurea and placebo therapies on glucose tolerance, blood metabolites and insulin secretion in diabetics. Diabetologia, 11, 369

    Google Scholar 

  47. Clarke, B. F. and Campbell, I. W. (1975). Long term comparative trial of gliben- clamide and chlorpropamide in diet-failed, maturity-onset diabetics. Lancet, I, 246

    Article  Google Scholar 

  48. Logie, A. W., Galloway, D. B. and Petrie, J. C. (1976). Drug interactions and long term antidiabetic therapy. Br. J. Clin. Pharmacol 3, 1027

    Article  PubMed  CAS  Google Scholar 

  49. Ungar, G., Freedman, L. and Shapiro, S. L. (1957). Pharmacological studies of a new oral hypoglycaemic drug. Proc. Soc. Exp. Biol, 95, 190

    PubMed  CAS  Google Scholar 

  50. Tomkin, G. H., Hadden, D. R., Weaver, J. A. and Montgomery, D. A. D. (1971). Vitamin - B12 status of patients on long term metformin therapy. Br. Med. J, ii, 685

    Article  Google Scholar 

  51. Cohen, R. D. and Woods, H. F. (1976). Clinical and Biochemical Aspects of Lactic Acidosis. ( Oxford: Blackwell Scientific Publications )

    Google Scholar 

  52. Cohen, R. D. (1978). Prevention and treatment of lactic acidosis. In D. W. Vere (ed.). Topics in Therapeutics, 4th ed. pp. 191–197. ( London: Pitman )

    Google Scholar 

  53. Assan, R., Heuclin, C., Ganeval, D., Bismuth, C., George, J. and Girard, J. R. (1977). Metformin-induced lactic acidosis in the presence of acute renal failure. Diabetologia, 13, 211

    Article  PubMed  CAS  Google Scholar 

  54. Annual Report for 1977 of the Medicines Commission (1978), p. 22. ( London: Her Majesty’s Stationery Office )

    Google Scholar 

  55. Bismuth, Ch., Gaultier, M., Conso, F., Heuclin, Ch. and Assan, R. (1976). Acidose lactique induite par l’ingestion excessive de metformine. Nouv. Presse Med, 5, 261

    PubMed  CAS  Google Scholar 

  56. Mirouze, J., Mion, C., Beraud, J. J. and Salem, J. L. (1976). Acidose lactique à l’occasion d’insuffisence renale chez deux diabétique traites par metformine. Nouv. Presse M éd., 5, 1004

    Google Scholar 

  57. Schlichtkrull, J., Brange, J., Christiansen, AA. H., Hallind, O., Heding, L. G., Jorgensen, K. H., Munkgaard Rasmussen, S., Sorensen, E. and Volund, Aa. (1974). Monocomponent insulin and its clinical implications. In R. Levene and E. E. Pfeiffer (eds.). Radioimmunoassay: Methodology and Applications in Physiology and Clinical Studies, Hormone and Metabolic Research, pp. 134–143 ( Stuttgart: Georg Theime )

    Google Scholar 

  58. Anderson, J. (1976). Blood sampling and diabetic control. Lancet, ii, 794

    Article  Google Scholar 

  59. Editorial (1976). Glycosylated haemoglobin and diabetic control. N. Engl J. Med, 295, 443

    Article  Google Scholar 

  60. Koenig, R. J., Peterson, C. M., Jones, R. L., Sandek, C. Lehrman, M. and Cerami, A. (1976). Correlation of glucose regulation and haemoglobin Ale in diabetes mellitus. N. Engl. J. Med, 295, 417

    Article  PubMed  CAS  Google Scholar 

  61. Gonen, B., Rubenstein, A., Rochman, H., Tanega, S. P. and Horwitz, D. L. (1977). Haemoglobin Al: An indicator of the metabolic control of diabetic patients. Lancet, ii, 734

    Article  Google Scholar 

  62. SĂ´nksen, P. H., Judd, S. L. and Lowy, C. (1978). Home monitoring of blood glucose. Lancet, i, 729

    Article  Google Scholar 

  63. Walford, S., Gale, E. A. M., Allison, S. P. and Tattersall, R. B. (1978). Self- monitoring of blood glucose. Lancet, i, 732

    Article  Google Scholar 

  64. Gale, E. A. M. and Tattersall, R. B. (1978). Hypothermia: a complication of diabetic ketoacidosis. Br. Med. J, 2, 1387

    Article  PubMed  CAS  Google Scholar 

  65. Alberti, K. G. M. M. and Hockaday, T. D. R. (1977). Diabetic coma: a reappraisal after five years. Clin. Endocrinol. Metab, 6, 42

    Google Scholar 

  66. Schecter, A. E., Wiesel, B. H. and Cohn, C. (1941). Peripheral circulatory failure in diabetic acidosis and its relation to treatment. Am. J. Med. ScL, 202, 364

    Article  CAS  Google Scholar 

  67. Ditzel, J., Anderson, H. and Daugaard, N. (1972). Tissue oxygenation in uncontrolled diabetes mellitus. Lancet, ii, 818

    Article  Google Scholar 

  68. Greenaway, J. M. and Read, J. (1958). Diabetic coma; a review of 69 cases. Aus-t. Ann. Med, 7, 151

    CAS  Google Scholar 

  69. Baum, D., Dillard, D. H. and Porte, D. (1968). Inhibition of insulin release in infants undergoing deep hypothermic cardiovascular surgery. N. Eng. J. Med, 279, 1309

    Article  CAS  Google Scholar 

  70. Wynn, V. (1954). Electrolyte disturbances associated with failure to metabolise glucose during hypothermia. Lancet, ii, 575

    Article  Google Scholar 

  71. Young, J. B. and Landsberg, L. (1977). Catecholamines and intermediary metabolism. Clin. Endocrinol. Metab, 6, 599

    Article  PubMed  CAS  Google Scholar 

  72. Sprunt, J. G., Maclean, D. and Browning, M. C. K. (1970). Plasma — corticosteroid levels in accidental hypothermia. Lancet, i, 324

    Article  Google Scholar 

  73. Page, M. McB., Alberti, K. G. M. M., Greehwood, R., Gumaa, K. A., Hockaday, T. D. R., Lowy, C., Nabarro, J. D. N., Pyke, D. A., Sonksen, P. H., Watkins, P. J. and West, T. E. T. (1974). Treatment of diabetic coma with continuous low-dose infusion of insulin. Br. Med. J, 1, 687

    Article  Google Scholar 

  74. Alberti, K. G. M. M., Hockaday, T. D. R. and Turner, R. C. (1973). Small doses of intramuscular insulin in the treatment of diabetic ‘coma’. Lancet, ii, 515

    Article  Google Scholar 

  75. Shaw, K. M., Tillyer, C. R., Morgan, P. G. M. and Bloom, A. (1974). Small doses of intramuscular insulin in the treatment of diabetic ‘coma’. Lancet, i, 1115

    Article  Google Scholar 

  76. Field, J. B. (1976). Hyperosmolar coma. In S. S. Fajan (ed.) Diabetes Mellitus pp. 133–141. London Department of Health Education and Welfare Publication No. (NIH)) 76–854

    Google Scholar 

  77. Matz, R. (1972). Hyperosmolar coma. Lancet, ii, 1254

    Article  Google Scholar 

  78. Gerich, J., Martini, M. M. and Recant, L. (1971). Clinical and metabolic characteristics of hyperosmolar non-ketotic coma. Diabetes, 20, 228

    PubMed  CAS  Google Scholar 

  79. McCurdy, D. K. (1970). Hyperosmolar hyperglycaemic non-ketotic diabetic coma. Med. Clin. N. Am, 54, 683

    PubMed  CAS  Google Scholar 

  80. Cheng, H. (1979). Photocoagulation and diabetic retinopathy. Br. Med. J, 1, 365

    Article  PubMed  CAS  Google Scholar 

  81. Kohuer, E. M. (1977). Diabetic retinopathy. Clin. Endocrinol. Metab, 6, 345

    Article  Google Scholar 

  82. Job, D., Eshwege, E., Argenton, C. G., Aubry, J. P. and Tchobroutsky, G. (1976). Effect of multiple daily insulin injections on the course of diabetic retinopathy. Diabetes, 25, 463

    Article  Google Scholar 

  83. Interim Report of a Multicentre Controlled Study (1975). Photocoagulation in the treatment of diabetic maculopathy. Lancet, ii, 1110

    Google Scholar 

  84. Diabetic Retinopathy Study Research Group (1976). Preliminary report on effects of photocoagulation therapy. Ophthalmology, 81, 383

    Google Scholar 

  85. Patz, A., Schatz, H., Berkow, J. W., Gittlesohn, A. M. and Ticho, G. (1973). Macular oedema, an overlooked complication of diabetic retinopathy. Trans. Am. Acad. Ophthalmol. Otolaryngol, 77, 34

    Google Scholar 

  86. Cheng, H., Kohuer, E. M. and Bailey, J. and others (1977). Photocoagulation in proliferative diabetic retinopathy. Br. Med. J, 1, 739

    Article  Google Scholar 

  87. Caird, F. I., Hutchinson, M. and Pirie, A. (1965). Cataract extraction in diabetes. Brit. J. Ophthalmol, 49, 466

    Article  CAS  Google Scholar 

  88. Thornton, G. F., Lytton, B. and Andriole, V. T. (1966). Bacteriuria during indwelling catheter drainage. J. Am. Med. Assoc, 195, 179

    Article  CAS  Google Scholar 

  89. Warren, J. W., Piatt, R., Thomas, R. J., Rosner, B. and Kass, E. H. (1978). Antibiotic irrigation and catheter-associated urinary tract infections. N. Engl. J. Med, 299, 570

    Article  PubMed  CAS  Google Scholar 

For further reading

  • Cudworth, A. G. (1977). The aetiology of diabetes. In M. Besser (ed.). Advanced Medicine, 13, pp. 163–172. ( London: Pitman Medical )

    Google Scholar 

  • Alberti, K. G. M. M. and Nattrass, M. (1977). Metabolic disorders of diabetes and their management. In M. Besser (ed.). Advanced Medicine, 13, pp. 173–189. ( London: Pitman Medical )

    Google Scholar 

  • Hall, R. and Anderson, J. (1978). Endocrinology and diabetes mellitus. In A. R. Horler and J. B. Foster (eds.). Progress in Clinical Medicine, 7th ed., pp. 52–68. ( London: Churchill Livingstone )

    Google Scholar 

  • Watkins, P. J. (1977). Oral hypoglycaemic drugs. Prescribers J, 4, 76

    Google Scholar 

  • Pyke, D. A. (1976). Up to date on diabetes. In D. K. Peters (ed.). Advanced Medicine, 12, pp. 236–250 ( London: Pitman Medical )

    Google Scholar 

  • Sönksen, P. H. (1977). New insulins. In M. Besser (ed.). Advanced Medicine, 13, pp. 402–412. ( London: Pitman Medical )

    Google Scholar 

  • Tattersall, R. (1978). Highly purified insulins. Prescribers J, 18, 8

    Google Scholar 

  • Editorial (1975). Oral hypoglycaemics in diabetes mellitus. Lancet, ii, 489

    Google Scholar 

  • Bloom, A. (1977). Some practical aspects of the management of diabetes. Clin. Endocrinol Metab, 6, 499

    Article  PubMed  CAS  Google Scholar 

  • Davidson, M. B. (1979). The effect of aging on carbohydrate metabolism: A review of the English literature and a practical approach to the diagnosis of diabetes mellitus in the elderly. Metabolism, 28, 688

    Article  PubMed  CAS  Google Scholar 

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Jackson, R.A. (1980). Treatment of the elderly diabetic. In: Denham, M.J. (eds) The Treatment of Medical Problems in the Elderly. Current Status of Modern Therapy, vol 3. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-6223-4_5

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