Diabetes im Alter: HbA_1c und wie weiter?

Zusammenfassung

Die Angabe von HbA_1c-Korridoren, abhängig von Folge- und Begleiterkrankungen des Diabetes, der Multimorbidität und bestehenden funktionellen Einschränkungen hat sich für die Blutglukose-Zielplanung des geriatrischen Patienten inzwischen weltweit etabliert. Dabei darf das Erreichen eines gesetzten HbA1c-Zieles nicht die Gefahren von schweren Hypoglykämien oder längerfristigen Hyperglykämien aus den Augen geraten lassen. Bei langdauernder Diabeteserkrankung mit über Jahre hinweg schlechter HbA_1c-Einstellung und bestehender kardiovaskulärer Begleitmorbidität ist eine zu straffe Blutglukoseeinstellung mit starker HbA_1c-Senkung für den älteren Menschen eher schädlich als nützlich.

Abstract

HbA_1c is a surrogate parameter used to determine metabolic control. In old age different conditions influence erythrocyte half-life falsifying the validity of HbA_1c. In older people with diabetes the ranges of HbA_1c are frequently chosen higher. However hypoglycemia cannot be ruled out even with high HbA_1c levels. Functional aspects, especially regarding cognitive function, are important to choose treatment goals, mainly regarding the risk of hypoglycemia.

Schlüsselwörter

Diabetes mellitus - HbA_1c - Geriatrie

Keywords

type-2 diabetes - glycosylated hemoglobin - geriatric patients

• Literatur

• 1 ADA 2010. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 (Suppl. 01) S62-69
• 2 Bruce DG, Davis WA, Casey GP et al. Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study. In: Diabetologia 2009; 52: 1808-1815
• 3 Chon SL, Yun J, Fraterrigo G et al. Evaluation of glycemic variability in well-controlled type 2 diabetes mellitus. In: Diabetes Technol Ther 2013; 15: 455-460
• 4 Chow E, Bernjak A, Williams S et al. Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk. Diabetes 2014; 63: 1738-1747
• 5 International Diabetes Federation. IDF Global Guideline For Mamaging Older People with Diabetes. www.idf.org/guidelines/managing-older-people-type-2-diabetes Letzter Zugriff 12.5.2015
• 6 Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012; 55: 1577-1596
• 7 Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015; 38: 140-149
• 8 Kirkman MS, Briscoe V, Jones C et al. Diabetes in older adults. Diabetes Care 2012; 35: 2650-2664
• 9 Laiteerapong N, Karter AJ, Liu JY et al. Correlates of quality of life in older adults with diabetes: the Diabetes & Aging Study. Diabetes Care 2011; 34: 1749-1753
• 10 Munshi MN, Segal AR, Suhl E et al. Frequent hypoglycemia among elderly patients with poor glycemic control. Arch Intern Med 2011; 171: 362-364
• 11 Roberts RO, Knopman DS, Geda YE et al. Association of diabetes with amnestic and nonamnestic mild cognitive impairment. Alzheimers Dement 2014; 10: 18-26
• 12 Sinclair A, Morley JE, Rodriguez-Mañas L et al. Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. J Am Med Dir Assoc 2012; 13: 497-502
• 13 Whitmer RA, Karter AJ, Yaffe K et al. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 2009; 301: 1565-1572
• 14 Yaffe K, Falvey CM, Hamilton N et al. Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Int Med 2013; 173: 1300-1306
• 15 Zeyfang A, Bahrmann A, Wernecke J. Diabetes mellitus im Alter. Diabetologie und Stoffwechsel 2015; 9: S189