NON-INSULIN-DEPENDENT DIABETES-MELLITUS IN THE ELDERLY

The prevalence of non-insulin-dependent diabetes mellitus dramatically increases with age. Older diabetic subjects have an increased frequen cy of complications from diabetes compared with their younger counterp arts and higher morbidity and mortality rates compared with age-matche d non-diabetic controls. Elderly patients with diabetes are generally treated following the same approach as in younger patients: dietary th erapy first, followed by oral hypoglycaemic agents and ultimately insu lin. However, several specificities should be pointed out. Changes ass ociated with ageing may affect the pharmacokinetics and pharmacodynami cs of both sulphonylureas (increasing the risk of severe hypoglycaemia ) and biguanides (increasing the risk of lactic acidosis). The best in sulin regimen in old age is not known, but a twice-daily injection of a pre-mixed insulin preparation is usually recommended. Goals of thera py must be realistic and not cause disabling side-effects. The general practitioner plays a crucial role in the care of elderly diabetic pat ients, but access to a multidisciplinary specialized team may be neces sary.