Diabetes in Old Age

Edited by Alan J. Sinclair, Foundation for Diabetes Research in Older People, Diabetes Frail Ltd and University of Aston, UK Trisha Dunning, Centre for Nursing and Allied Health Research, Deakin University and Barwon Health, Geelong, Australia Leocadio Rodríguez Mañas, Servicio de Geriatría, Hospital Universitario de Getafe and Universidad Europea de Madrid, Spain Medha Munshi, Joslin Geriatric Diabetes Programs, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA

Preface vii

Foreword viii

List of Contributors xi

Section A: Pathophysiology, screening and diagnosis 1

1 Pathophysiology of diabetes in older people 3
Graydon S. Meneilly

2 Type 1 diabetes in older age 13
Medha Munshi and Alan J. Sinclair

3 Preventative strategies 20
Edward S. Horton

4 Diagnosis and screening 29
Jorge Manzarbeita

5 Assessment procedures including comprehensive geriatric assessment 43
Willy Marcos Valencia, Marie Danet, and Hermes Florez

Section B: Vascular risk factors and complications 55

6 Peripheral arterial disease 57
Leocadio Rodríguez Mañas, Cristina Alonso Bouzon, and Marta Castro Rodríguez

7 Coronary heart disease 67
Ahmed H. Abdelhafiz

8 Chronic kidney disease related to diabetes in older patients 84
Isaac Sinay and Felipe Inserra

9 Visual loss in people with diabetes in old age 106
Peter H. Scanlon

10 Diabetes foot disease 113
Srikanth Bellary

11 Diabetes, neuropathy, and old age 125
Jennifer Dineen and Christopher Gibbons

12 Sensory disabilities in people with diabetes 137
Rowan Hillson

13 Sexual health and wellbeing 148
Geoffrey I. Hackett

14 eHealth and diabetes: Designing a novel system for remotely monitoring older adults with type 2diabetes 167
Elena Villalba‐Mora, Ignacio Peinado‐Martínez, and Francisco del Pozo

Section C: Treatment and care issues 177

15 Insulin resistance and the metabolic syndrome 179
Andrew J. Krentz and Angelo Scuteri

16 Diabetes and functional limitation: The emergence of frailty and disability 213
Leocadio Rodriguez Manas and Alan J. Sinclair

17 Metabolic decompensation in older people 225
Giuseppe Paolisso and Michelangela Barbieri

18 Nutrition management 240
Trisha Dunning

19 Physical exercise management 267
Mikel Izquierdo and Eduardo Lusa Cadore

20 Medicines, pharmacovigilance, and the importance of undertaking comprehensive assessmentsand regular medicine reviews 277
Trisha Dunning

21 Glucose‐lowering drugs 298
Andrew J. Krentz and Alan J. Sinclair

22 Insulin therapy 323
Ahmed H. Abdelhafiz

23 Hypertension in older diabetic patients 338
N. Jain, A. Chikara, and A. Goel

24 Hypoglycemia 350
Medha Munshi

25 Diabetes in care homes 360
Trisha Dunning and Alan J. Sinclair

26 Primary and community care of diabetes in older people 376
Mark Kennedy

27 Inpatient diabetes care and admissions avoidance in older people with diabetes 395
Belinda Allan, Ketan Dhatariya, Esther Walden, Carol Jairam, and Mike Sampson

Section D: Management of associated complications 411

28 Diabetes and co‐morbidities 413
Marta Castro Rodríguez and Leocadio Rodríguez Mañas

29 Diabetes and cognitive dysfunction 426
Alan J. Sinclair

30 Mood disorders 437
Ahmed H. Abdelhafiz and Alan J. Sinclair

31 Falls and diabetes 448
Cristina Alonso Bouzón and Medha Munshi

32 Managing pain 456
Trisha Dunning

33 Palliative and end‐of‐life care 470
Trisha Dunning and Alan J. Sinclair

Section E: Optimizing diabetes care in older people 489

34 Diabetes education and the older adult 491
Elizabeth A. Beverly, Arlene Smaldone, and Katie Weinger

35 Supporting the family and informal carers 505
Alan J. Sinclair and Trisha Dunning

36 Public health issues and community impact 516
Luis Miguel Gutiérrez Robledo and Roger Gadsby

37 Providing cost‐effective diabetes care 525
Chia‐Hung Chou and Elbert S. Huang

38 Clinical trials in older people 533
Olga Laosa, Marta Checa, and Laura Pedraza

Index 543