Diabetes mellitus and cardiovascular disease in older adults

Type 2 diabetes is increasing worldwide and is frequent among older patients. Special care and consideration should be given when caring for older patients with diabetes. Comorbid illness, functional status, and shortened life expectancy are additional considerations that may significantly affect the benefits of diabetes treatments in this population. Poorly controlled diabetes leads to microvascular and macrovascular complications, which can both result in significant morbidity and mortality. Evidence shows that tight glycemic control lowers the risk of microvascular complications in type 1 diabetes, but less impressively in type 2 diabetes. Trials investigating macrovascular outcomes in older patients treated with more aggressive glycemic goals have not shown clear benefit and suggested potential harm. Multiple options exist for the treatment of hyperglycemia in type 2 diabetes. These include oral agents, noninsulin injectables, and insulin therapy. In addition to controlling hyperglycemia, these agents may have positive, negative, or neutral cardiovascular-related effects. With an aging population, diabetes among older adults will continue to represent a growing problem. Individualized goals of care for glycemic control are often appropriate in this population. It is also important to address cardiovascular risk factor reduction (including antiplatelet therapy, lipid-lowering, and blood pressure control) when managing diabetes in the older patient.