Current Status and Issues of Diabetes Treatment—How to Deal with Elderly Patients with Type 2 Diabetes—

Abstract

 Elderly people, who made up only 7% of the population in 1970, had been more than 25% of the population in 2019, and one woman will have 1.42 children in her lifetime in Japan. Increasing in aging population with the declining birthrate in our country is progressing with an extremely rapid rate, and that the medical costs of the elderly will be close to 80% of the total medical costs after 2040 when the aging peaks. As the number of elderly people increases, the number of elderly patients with type 2 diabetes is also increasing. According to the 2018 National Nutrition Survey, 18.7% of men and 9.3% of women are HbA1c above 6.5% or under treatment of diabetes mellitus. At age 70 and over, 24.6% of men and 15.7% of women are living with diabetes and the numbers increase with age.

 Along with the aging of patients with diabetes, dementia, cancer, fracture, depression, periodontal disease and so on are major factors that lower the QOL of patients. Furthermore, in elderly diabetic patients, hyperglycemia itself causes not only vascular disorders but also senile syndromes such as sarcopenia, flail, malnutrition and heart failure. Age-related decline in renal function increases the risk of hypoglycemia during treatment.

 How to deal with elderly people with diabetes is not trivial. It is necessary to fully consider whether the preventive evidence shown in young adults and the elderly in the early period is appropriate for the elderly in the late stage and elderly patients requiring medical care. On top of that, it seems that the basic stance of properly prescribing a minimum of drugs and performing mild blood glucose control is important.