21 July 2019
A regular medical checkup is crucial for those at high risk of developing diabetes. Photo: Reuters
A regular medical checkup is crucial for those at high risk of developing diabetes. Photo: Reuters

Diabetes management for elderly patients

Chan, 70, had lost appetite for days and was sent to the hospital by her worried family for her absent-mindedness.

The emergency department observed her deteriorating health and directed her case to the internal medicine and geriatrics department for further diagnosis.

Chan was discovered to have type 2 diabetes. The surge in her blood sugar level was traced to urethritis, which was further complicated by dehydration and a disoriented mind.

Common symptoms of diabetes include weariness, frequent urination, feeling thirsty, unintended weight loss, and so on.

However, these symptoms do not usually appear among elderly patients. Instead, they may experience dehydration, disoriented mind, urinary incontinence and diabetes complications such as diabetic neuropathy, diabetic retinopathy and renal failure.

Patients and their caretakers may overlook the correlation between these health problems and diabetes. There are not many early symptoms either.

Most diabetes patients have caught the disease over a fairly long period. A regular medical checkup is therefore very crucial. Caretakers should also pay more attention to physical changes of seniors.

The goals of diabetes treatment for elderly patients are to reduce symptoms, prevent and lower the risk of acute or chronic diabetes complications, and minimize risk factors and medical burden.

Medications that come with side effects, such as low blood sugar level, should be avoided because they may cause dizziness and result in accidental falling and bone fractures among patients.

That said, geriatric physicians are especially careful when they make prescriptions for the elderly. This is because medical researchers rarely take samples from seniors and their statistics may not apply to elderly patients. Doctors should have a thorough understanding of the elderly patient’s physical conditions and medication habits in order to assign the most suitable prescriptions.

The normal HbA1c level, which is less than 7 percent, may not be an ideal measurement for diabetes patients aged 65 or above. The ideal range should depend on factors such as chronic diseases, diabetes complications and life expectancy.

According to study that appeared in The Journal of the American Medical Association in 2016, the ideal HbA1c level for a diabetic patient over 65 years old should range from 7.5 to 9 percent. However, readings can be misled by anemia, recent blood transfusion, erythropoietin treatment or chronic renal disease.

At the end of the day, doctors should set realistic goals in diabetes management, with the patient’s willingness, financial background, life expectancy and medication risks all taken into consideration.

This article appeared in the Hong Kong Economic Journal on April 6

Translation by John Chui

[Chinese version 中文版]

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Specialist in geriatric medicine

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