[The care of the older person with diabetes mellitus].

The care of the older adult with diabetes mellitus should be individualized, taking into consideration the patient's functional status and coexistent illnesses, as well as his or her preferences and life expectancy. The overall goal of care is to improve both the clinical status and the quality of life. Components of care are education, glycaemic control, cardiovascular risk factor management, eye and foot care and management of nephropathy and geriatric syndromes. A team approach is recommended. Glycaemic control and cardiovascular risk factor modification can reduce the risk of complications and improve the quality of life. However, the risk of severe or fatal hypoglycaemia associated with the use of anti-hyperglycaemic drugs increases with age and comorbidity. Targets for glycaemic control and HbA1c should be realistic, dynamic and tailored to the characteristics of each individual patient. Since cardiovascular complications are the main cause of morbidity and mortality, managing cardiovascular risk factors is mandatory. Hypertension should be treated gradually. The therapeutic approach comprises lifestyle modifications and anti-hyperglycaemic drugs. Older persons should be evaluated regularly to assess and review the medication being used. An appropriate physical activity, especially walking can forestall functional decline and decrease all-causes and cardiovascular mortality. Identifying and managing such geriatric syndromes as dehydration, cognitive dysfunction and depression may improve the quality of life.