title: Avoiding hypoglycaemia: a new target of care for elderly diabetic patients.
abstract: Optimising glycaemic control to prevent diabetes-associated complications has received much attention. The associated risk of iatrogenic hypoglycaemia, however, is inevitable and can have a significant impact on health. The prevalence of iatrogenic hypoglycaemia tends to increase with advancing age. Elderly people are intrinsically prone to hypoglycaemia. Ageing attenuates the glucose counter-regulatory and symptomatic response to hypoglycaemia, particularly in the presence of a longer duration of diabetes. Multiple co-morbidities and polypharmacy correlated with advancing age also increase the hypoglycaemic risk. In addition to the acute adverse effects of hypoglycaemia, such as fall with injury, cardiovascular events and mortality, a hypoglycaemic episode can have long-term consequences. Repeated episodes may have a significant psychological impact and are also a risk factor for dementia. Because of the heterogeneous health status of the elderly, not all will benefit from optimal glycaemic control. Setting an individual glycaemic target and formulating a management plan that takes account of the patient's circumstances combined with balancing the benefit and risk of diabetes intervention to avoid hypoglycaemia is a more practical approach to the management of elderly diabetic patients.
authors.affiliation: Department of Medicine and Geriatrics, Caritas Medical Centre, Shamshuipo, Hong Kong.
authors.forename: C W
authors.initials: CW
authors.lastname: Wong
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000375:Aging / Q000097:blood*; D002318:Cardiovascular Diseases / Q000209:etiology; D015897:Comorbidity; D003704:Dementia / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D019338:Polypharmacy; D015995:Prevalence
keywords: Aged; Diabetes mellitus; Hypoglycemia