CINCINNATI—"Tight control” is something we hear a lot about when it comes to diabetes. The practice of tightly controlling blood glucose (blood sugar) levels can help people with diabetes to prevent or slow down the development of many of the disease’s complications.
But tight control isn’t necessarily for everyone, says UC Health endocrinologist Abid Yaqub, MD, adding that the elderly, especially, may not benefit from the tight control encouraged for younger generations of people with diabetes.
"There are a number of diabetes treatment ‘dos’ that should be thought through more carefully in older patients with diabetes,” says Yaqub, medical director of endocrinology at West Chester Hospital and associate professor of medicine at the University of Cincinnati.
With nearly 11 million people in the U.S. over age 65 with diabetes—more than a quarter of all people in this entire age group—Yaqub says consideration of individualized approaches to diabetes care is in order.
"Tight control focuses on keeping blood sugar as close to normal as possible at all times, and studies have shown that patients with a mission of tight control experience a higher incidence of low blood sugar, or hypoglycemia,” he says.
Low blood sugar can be a problem for any diabetes patient, Yaqub adds, but in the elderly, it can be particularly problematic.
"Intensive glycemic control in elderly diabetic patients with cardiovascular risk factors has been associated with increased death,” Yaqub says. "And severe hypoglycemia can have cardiovascular and neurological consequences more marked in elderly patients.”
Additional things to consider when it comes to tight control include:
• Falls. Low blood sugar can lead to falls, which can complicate diabetes care and affect an older patient’s independence.
• Medication adherence and "polypharmacy.” Because tight control is often achieved through medication, medication adherence can be problematic, as elderly patients often suffer from vision and dexterity problems.
"In addition, elderly patients often take multiple medications—something we term ‘polypharmacy’—so ensuring medications are properly managed becomes extremely important,” Yaqub says.
• Diet and physical activity. Both are key to blood sugar regulation, but older patients are more likely to suffer from depression, which can contribute to poor eating habits, and constraints on mobility can affect a person’s ability to exercise.
The right plan for managing diabetes in older patients, Yaqub says, will depend upon a more personalized approach to setting targets for blood sugar control and designing treatment regimens for achieving these targets.