Diabetes Mellitus at an Elderly Age

Due to the good medical care in Germany, many people with diabetes mellitus now reach old age: Of the 340,000 adults with type 1 diabetes, more than 100,000 are over 70 years of age. Approximately 8 million people have type 2 diabetes and one-fourth of this group is over 75 years of age, and approximately 1 million over the age of 80 [1].

Nationwide, there are a total of about 630,000 people with diabetes mellitus in need of care. The statements in the practice recommendations are mainly directed at the majority of elderly people with type 2 diabetes and can only reflect some of the special characteristics of elderly people with diabetes. Topics such as type 1 diabetes at an elderly age, end of life, interface management or ethics are covered in the complete S2k guideline.

The geriatric patient is defined by multimorbidity and a higher age. Age-typical functional limitations and high vulnerability create a special need for action that goes beyond blood glucose control and the management of cardiovascular risk factors or diabetes-typical complications. For differentiated therapy planning, elderly patients should be divided into functional groups ([Tab. 1]).

Tab. 1 Classification into functional groups.

Patient group	Patient description
Functionally independent	Elderly people with diabetes mellitus and good functional status. Patients with low comorbidity, at best low cognitive impairment and good compensation possibilities
Functionally slightly dependent	Elderly people with diabetes mellitus and limited functional status. Patients with multimorbidity, functional and cognitive limitations and geriatric syndromes
Functionally highly dependent	Elderly people with diabetes mellitus and extremely limited functional status or terminally ill people. Patients with multimorbidity, geriatric symptoms, pronounced functional and cognitive limitations and the presence of diseases with limited life prognosis, e. g. terminal heart, kidney or malignant diseases
End of life	People who are on their deathbed

A geriatric assessment should be conducted to determine resources and deficits (division into functional groups) (Practice Tool 1, see Appendix).

Publication History

Article published online:
13 January 2023

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