Zaragoza, May 27, 2013 - The prevalence of type 2 diabetes increases with age and it is estimated that, worldwide, over the next two decades the epidemic of this disease will be particularly significant in the population over 65 years .
In Spain, according to Di @ betes1 study, the prevalence of diabetes in elderly patients over 75 years is about 30% of the population and is almost 40% older than 85 years.
Given this situation and the XX Congress of General and Family Medicine, held in Zaragoza, organized the meeting Novartis 'therapeutic targets in the elderly diabetic patient' in order to discuss the main challenges in addressing elderly patient with type 2 diabetes.
According to Dr. Carlos Miranda Fernandez-Santos, Family Medical Health Center Buenavista Toledo, coordinator of the Spanish Diabetes Society of General Practitioners and Family (SEMG) and moderator of the meeting: "The aim of This meeting focuses on addressing diabetes and other cardiovascular risk factors in the context of the elderly patient. "
The elderly diabetic patient has specific as the presence of comorbidities, a high clinical heterogeneity geriatric symptoms (cognitive impairment, depression or falls) and an increased risk of morbidity and mortality, among others, that necessitate a specific approach of the pathology. In this sense, says Dr. Miranda Fernandez-Santos "when treating a patient with these characteristics is necessary to individualize each case, since as stated Consensus Document on the treatment of elderly diabetic patient, which has participated and endorsed the SEMG, therapeutic goals in diabetic elderly patients vary with age and the patient's own situation. "
Among the topics covered in the panel discussion included the reflection on the importance of glycemic control targets to achieve a correct approach to the elderly diabetic patient. According to Dr. Francesc Formiga, program director of Geriatrics, Internal Medicine Hospital of Bellvitge in Barcelona, "the goals of glycemic control of elderly patient should be individualized and always take into account the patient's opinion and involve you in the whole process . Although therapeutic options are the same as for the young, the elderly, these options will have to be adapted to various aspects such as kidney function, frailty, decreased visual acuity, the presence or absence of a qualified, among others, always depending on the patient's profile. "
The duration of diabetes and total life expectancy and active patient are of great importance to the planning of therapeutic goals. So says Dr. Formiga "in deciding the therapeutic goals should be considered two different scenarios: first, in the elderly with functional and cognitive capabilities preserved without major complications or comorbidities and good life expectancy, are recommends a target HbA1c of 7% -7.5%. Moreover, in the group of frail elderly with disabilities (physical and / or cognitive) and major complications and / or comorbidities, and a short life expectancy, the control objectives should be less stringent (HbA1c 7.6 % -8.5%). Clearly, the low life expectancy disappear from view very strict control objectives that provide benefits in the medium to long term. "
Another issue discussed at the meeting refers to the use of dipeptidyl peptidase 4 (IDPP4) compared with sulfonylurea-based treatments in the elderly with diabetes. In the words of Dr. Concepcion Vidal, Deputy Department of Endocrinology and Nutrition, Hospital Royo Villanova Zaragoza: "The drugs IDPP4 are easy to handle in a single daily dose or in two doses in combination with metformin, with similar reductions in HbA1c and little risk of hypoglycemia. Meta-analyzes with IDPP4 in large population samples seem to show that their use reduces the risk of cardiovascular events, particularly myocardial infarction and mortality from all causes in people with type 2 diabetes, this treatment caused positioned as the optimum in all phases of the disease. In this sense, his qualification is suited to situations of renal failure and its use is becoming widespread in both elderly and in patients debutantes more evolved ".
Finally, experts have debated the factors that limit the elderly diabetic patient management in primary care. According to Dr. Francisco Key, Medical Primary Care Service Hospital High Resolution The Toyo Almeria, "the elderly patient with type 2 diabetes has a number of characteristics and constraints that must be considered when using or most suitable drugs: on one hand, the quality of life, to be good or acceptable in some cases, while in others there will be a significant reduction in patients instrumental abilities and high comorbidity, and secondly, chronic complications, for some patients present micro and macrovascular complications, while in others, the newly diagnosed, it will be little or no ".
Dr. Francisco Key has also stated that neither "can forget the major geriatric syndromes that, by themselves, can condition treatment and reduce life expectancy, such as cognitive impairment, depression, accidental falls, polypharmacy, urinary incontinence or chronic pain, to name the most common. "
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1. Soriguer F, Goday A, Bosch-Comas A, Bordiú E, Calle-Pascual A, Carmena R, Casamitjana R, Brown L, Castell C, Catala M, Delgado E, Franch J, Gaztambide S, Girbés J, Gomis R, Gutiérrez G, López-Alba A, Martínez-Larrad M. T, Menéndez E, Mora-Peces I, Ortega E, Pascual-Mannich G, Rojo-Martínez G, Serrano-Rios M, Valdés S, Vázquez J. A Vendrell J. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study. 2011
Image By IntDiabetesFed [Public domain], via Wikimedia Commons