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Hosp Pract (1995). 2013 Oct-Nov;41(4):51-6. doi: 10.3810/hp.2013.10.1080.

Elderly patients with type 2 diabetes mellitus-the need for high-quality, inpatient diabetes care.

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1
Professor of Geriatric Medicine, Department of Gerontology-Centre Hospitalier Universitaire (CHU) de Bordeaux, France; RMSB UMR 5536 CNRS, Bordeaux, France; RMSB UMR 5536 Bordeaux Segalen University, Bordeaux, France. isabelle.bourdel-marchasson@chu-bordeaux.fr.

Abstract

Elderly patients (aged > 70 years) with diabetes are at high risk of -hospitalization. We provide a detailed commentary about recent international clinical guidelines and a consensus statement devoted to elderly patients with type 2 diabetes mellitus in the context of hospitalization. In emergency departments, the 4 medication agents associated with the greatest number of patient adverse drug events are warfarin, oral glucose-lowering medications, insulin, and antiplatelet agents, all of which are commonly prescribed in older patients with diabetes. Comprehensive gerontological assessment, including review and, if indicated, discontinuation of all potentially unsafe or inappropriate patient medications should be done upstream to reduce the likelihood of adverse drugs events. Severe infections and ischemic heart disease are also frequent causes of acute admission into hospital in patients aged > 75 years. These patients are also likely to be malnourished and nutritional status should be monitored. Nutritional support, combined with specific products to avoid uncontrolled hyperglycemia must be implemented in patients at risk of malnutrition. Early exercise prescription may help patients maintain physical function and prevent the risk of falling. Clinical guidelines should be applied to achieve safe and effective patient target glucose levels. Insulin should be used earlier for its anabolic properties and patients closely monitored to reduce the risk of hypoglycemia and excessive hyperglycemia. The discharge plan needs to address full medical and social needs along with suitable follow-up to ensure a high level of patient safety.

PMID:
24145589
DOI:
10.3810/hp.2013.10.1080
[Indexed for MEDLINE]
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