Type 2 Diabetes Treatment in Older Patients

Type 2 diabetes is a severe condition that requires constant and careful treatment. According to Zheng, Ley, and Hu (2017), the number of people with diabetes has increased fourfold in the past three decades, and diabetes mellitus is considered the ninth major cause of death. Moreover, 90% of adults with diabetes suffer from type 2 diabetes mellitus. Type 2 diabetes can be managed in several ways, such as physical activity, maintaining a healthy and balanced diet, and regularly visiting a doctor in case of developing complications. However, some patients require a more intensive approach to treating diabetes, such as admission to hospital care. These patients are primarily older people because, with age, a person is at a higher risk of losing control over the illness. I have evaluated my care episode with one of the older patients in the hospital facility and based my research on this experience.

It is important to emphasize that all elderly patients with type 2 diabetes mellitus cannot be put into one group because they are not homogenous. Sinclair et al. (2019) report that older patients span four decades: people in their sixties, seventies, eighties, and nineties, respectively. They explain that there are significant differences between them; in other words, their physical and cognitive status varies from one patient to another (Sinclair et al., 2019). Moreover, elderly patients are likely to have various complications and additional health conditions that may interfere with pharmaceutical treatment. Therefore, medical experts need to apply an individual approach in diagnosing type 2 diabetes and assigning a treatment method for elderly patients.

Before establishing the treatment process, the patient needs to undergo screening and be assigned a diagnosis. Bigelow and Freeland (2016) describe the process of screening and diagnosing, mentioning obstacles that healthcare specialists might face. For example, the scholars warn that while the prevalence of type 2 diabetes increases with age, the typical symptoms, such as polyphagia, polydipsia, and polyuria, are more challenging to identify in elderly patients than in adults. These symptoms are less pronounced in older people with diabetes because “an impaired thirst mechanism and an increasing renal threshold for glucose increase with age” (Bigelow and Freeland, 2016, p. 182). Moreover, they are often associated with other chronic illnesses non-related to diabetes. Thus, people diagnosed with type 2 diabetes mellitus earlier in their life have a higher chance of survival than undiagnosed people or people with a late diagnosis.

In other words, incorrect attribution of symptoms, for example, fatigue, urinary inconsistence, nocturia, neuropathy, and poor wound healing, can significantly delay the diagnosis. Bigelow and Freeland (2016) continue that complex symptomology associated with diabetes forces elderly patients to receive their diagnosis either after regular sessions of screening or after the appearance of diabetic complications. Therefore, the American Diabetes Association advises starting the screening routine at the age of 45 to avoid the risk of an incorrect diagnosis (Bigelow and Freeland, 2016). This advice especially applies to overweight and obese individuals because they are at a higher risk of having diabetes.

Type 2 diabetes treatment consists of several steps: glucose control and self-monitoring, lifestyle changes and diet management, pharmacologic therapy, polypharmacy, prevention of complications, and coping. For glucose control, the American Geriatric Society recommends an HbA1c glucose target of 7.5%-8% for the general public, “depending on the patient’s characteristics, health status, life expectancy, and other chronic diseases” (Bigelow and Freeland, 2016, p. 182). Targets with higher percentages are advised to more vulnerable patients with poor health conditions. The scholars also note the complexity behind self-monitoring because the patients should be adequately educated on measuring their glucose levels. Moreover, the needs of elderly patients must be evaluated based on their dexterity, type of management, and cognitive skills. Appropriate self-monitoring technique eases the patients’ lives, providing a better insight into handling diabetes in a critical situation and allowing more independence from professional healthcare.

The next step is to maintain the lifestyle choices and the obesity level that significantly impact type 2 diabetes mellitus. Dietary regulations are essential in controlling diabetes; however, they are more difficult to impose on elderly patients. Adults develop strong eating habits by the age of 50, making the medical nutritionist’s work more challenging. In other words, older patients are less likely to follow the dietary rules and avoid foods that worsen their conditions if their ratio includes trans fats, sugar, and caffeine. Physical activity is another critical step in therapy, which also is less accessible for elderly patients. However, most of them require assistance, not necessarily from medical experts, because older people face a risk of hurting themselves while exercising. Moreover, healthcare specialists need to establish the relationship between glucose level and physical activity to measure the risk of hypoglycemia (Bigelow and Freeland, 2016, p. 183). Therefore, the question of safety receives the highest degree of concern among patients older than 60.

Some experts advise the usage of pharmacological and polypharmaceutical therapies depending on the efficiency of glucose targets. Bigelow and Freeland (2016) suggest that the goal of this type of treatment is “to achieve the best glycemic control without exposing the patient to the risk of hypoglycemia and its consequences” (p. 184). Therefore, patients taking insulin medications introduced in pharmacological therapy should be studied carefully for undesired reactions. Moreover, elderly patients need to have less strict glycemic goals because they are more vulnerable to the development of different complications.

Finally, the essential step in treating type 2 diabetes is healthy coping with the condition and psychological assistance to patients. Bigelow and Freeland (2016) report that diabetes is highly associated with depression; therefore, regular screening is advised. The most common are “the Geriatric Depression Scale, the Patient Health Questionnaire-2 or -9, and either the Diabetes Distress Scale or the Problem Areas in Diabetes Scale” (Bigelow and Freeland, 2016, p. 186). It is a problem of imperative significance because depression creates a risk for patients to neglect care, stop self-monitoring, and even harm themselves. Moreover, low condition of mental health provokes a decline in their physical health performance.

In conclusion, the current state of type 2 diabetes treatment requires more scientific research and the development of new care methods. This experience was important for my education because I received an insightful look at patient treatment. Elderly patients have a higher chance of dying from diabetes; therefore, it is critical for hospital care to analyze all complications and provide an individual approach to treatment. Regular screening helps to establish the correct diagnosis, which is imperative to receive appropriate treatment. The standard advised type of treatment includes glucose control and self-monitoring, physical activity and regulations in diet, and coping. In addition, pharmacologic therapy and polypharmacy are recommended for people with a more severe condition of diabetes.

Reference list

Bigelow, A., & Freeland, B. (2016). ‘Type 2 diabetes care in the elderly, The Journal for Nurse Practitioners, 13(3), p181-186. Web.

Sinclair, A.J., Abdelhafiz, A.H., Forbes, A. and Munshi, M. (2019). ‘Evidence‐based diabetes care for older people with type 2 diabetes: a critical review’, Diabetic Medicine, 36(4), p399-413. Web.

Zheng, Y., Ley, S. H., & Hu, F. B. (2017). ‘Global etiology and epidemiology of type 2 diabetes mellitus and its complications, Nature Reviews Endocrinology, 14(2), p88-98. Web.

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