Building Competency in Diabetes Education THE ESSENTIALS

CHANGES ACROSS THE LIFESPAN| 4-39

Figure 7 : Phenotype frailty model (87,90) Characteristics Scale • Weight loss • Exhaustion • Sedentary • Slow gait speed • Reduced grip strength 0 = fit 1-2 = pre-frail 3 or more = frail

Considerations in management Treatment regimens, especially with the elderly age group, need to be individualized according to (3,70,71,91): • Age

• Duration of diabetes • Risk for hypoglycemia • Presence of cardiovascular disease • Functionality • Life expectancy • Presence of comorbidities

With the natural process of aging, the older population is subject to multiple comorbidities often referred to as the “Geriatric Syndrome” (72). To complicate this, there are also many physiological changes directly related to diabetes. These include a progressive alteration in insulin secretion and insulin activity (74,75). Since the renal threshold for

Geriatric syndrome : • Depression

• Cognitive impairment

• Urinary incontinence

glucose increases with age, classic symptoms, such as polyuria and polydipsia, are often not helpful in the diagnosis of diabetes. Many elderly patients are diagnosed during a routine physical exam (75). The A1C also naturally rises with age which has sparked the debate as to the best diagnostic tool to use in this age group. Currently, the consensus suggests using a fasting plasma glucose and an A1C to diagnosis diabetes in the elderly (3,81). • Injurious falls • Persistent pain • Polypharmacy