How to approach to the therapy of diabetes in the elderly.

In gerontology diabetes mellitus (DM) is clinically the most frequent and extremely serious metabolic disorder. DM is an important health issue across the globe. With increasing life expectancy physicians are called upon to manage diabetes in the elderly more often. Senior patients suffer predominantly from the type 2 DM--T2DM (70+ up to 90-95%). Apart from genetic predisposition and an environmental influence, nutritional habits, modern lifestyle, stress and minor physical activity are of particular importance. Treatment options for T2DM in the elderly are diet, physical activity, various oral anti-diabetic drugs and insulin. At the start of treatment should primarily take into account: patient's age; self-sufficiency; late micro- and macro-vascular complications; social status; nutritional assessment (incl. dental status); other handicaps--psychic, motoric, visual and aural. Especially in frail, elderly patients, there should be less emphasis on strict glycaemic control than on avoiding malnutrition and hypoglycemia and achieving the best possible quality of life. Therapy of DM in this population is tightly connected with significant risks of micro- and macrovascular complications on one hand, and possible problems of the treatment (e.g. hypoglycemia) with intensive control on the other hand. To realize a comprehensive approach to therapy of diabetes in the old age a holistic approach with main aim improving quality of life is necessary.