One in five episodes of hypoglycemia in elderly patients with diabetes treated with insulin goes unnoticed due to the absence of the most common alarm symptoms, which are sweats, tremors and dizziness, as concluded in the Diabeclass meeting, organized byEsteve under the title 'The management of the elderly with type 2 diabetes'.
This circumstance is called inadvertent hypoglycemia syndrome and multiplies 6 or 7 the risk of serious hypoglycemia.The objective, has been pointed out, is to reduce its incidence through a less demanding glycemic control than in the rest of the patients.
More than half of the Spanish population with type 2 diabetes is over 65.The prevalence of this disease above 75 is 30.7 percent in men and 33.4 percent in women.
However, when speaking of the elderly, "we do not refer only to those over 65, said the professor of Medicine of the University Jaume I of Castellón." It is a term more related to the health status of each more patientthat with his chronological age, "he said.
An elderly patient is associated with fragility."They are usually pluripatological people, with high comorbidity, polymedicated, with some degree of dependence and a high risk of hypoglycemia," explained the head of the Internal Medicine Service of the Gregorio Marañón University General Hospital, Dr. Jesús Millán.
"Fragility influences the doctor in the face of therapeutic inertia and the maintenance of therapeutic decisions, even if it would be indicated to modify therapy, since increasing its intensity can increase the risk of hypoglycemia," he continued.
Therefore, the priority is to select a low risk treatment of hypoglycemia, since these patients are especially vulnerable to suffering an episode of this type.
That is, the concept of prima fragility above glycemic control, which must be less strict, mainly due to the possible consequences of hypoglycemia, which can range from a fall to cognitive problems, for example, to even death.
Higher prevalence of diabetes
Experts warn that changes in the lifestyle of young people will increase in the next 20 or 30 years exponentially the number of type 2 diabetics in Spain, which is currently 5 million.
"In 20 years we will attend to people who have lived their adolescence in the 80s, 90s and 2000s, with a totally different lifestyle from their parents and grandparents, which will result in a greater increase in the prevalence of diabetes,", Dr. Pallarés explained."IBERICAN data indicate that 19.8 percent of those over 18 served in primary care have diabetes, figures higher than current data," he added.
At the same time, 88 percent of those over 18 served in primary care have obesity or overweight and more than 50 percent are sedentary, which will not only increase the risk of diabetes, but also the risk of developing it at earlier ages.
In this sense, experts have claimed the need to initiate actions "to reverse this curve, because we are worse," said Dr. Pallarés.Above all, taking into account that "the best treatment for diabetes is its prevention from two basic pillars: food, exercise and weight control. It is in our hands," said Dr. Millán.
Kidney disease and other issues
Another of the issues addressed has been kidney disease, present in 60 percent of diabetic elderly patients, which makes it a more frequent morbidity than cardiovascular disease, in 50 percent ofcases.It also increases with age.
Nutritional advice from the diagnosis of diabetes taking into account the particularities of each patient, the usefulness of digital tools for professionals, patients and their families, or the medical-legal aspects of diabetes due to high mortality andGreater risk of sudden death of these patients, as a result of silent macrovascular complications, have also been commented during the meeting.
