The incidence of both type 1 (insulin-dependent) and type 2 diabetes mellitus is increasing worldwide, with the percentages of people aged 65 and over already exceeding 20-25% of the population, and with the highest percentage (~24%) occurring in people aged 75-79 years. At the same time, the number of elderly people with type 1 and type 2 diabetes who receive insulin in their treatment is progressively increasing, achieving a reduction in complications.

Incidence of diabetes in the elderly

In our country, over 1/4 of people with type 1 diabetes and almost 3/4 of people with type 2 diabetes are aged 65 and over. Many people with diabetes now live a quality and healthy life, even in their eighth decade, and given the improvement in life expectancy, it is a challenge to provide adequate medical care, especially if there are co-existing long-term conditions (e.g. hypertension, heart or kidney failure , etc.).

Hypoglycemia in the elderly

“Elderly people with diabetes are more prone to hypoglycemic episodes that require help from others due to numerous predisposing factors. Reduced cognitive ability, frequent problems with the musculoskeletal system and reduced functionality in their daily life entail an increased risk of hypoglycemia, accompanied by increased effects and possible worsening of several co-morbidities (cardiovascular-renal problems, dementia, motor problems, etc.).

Hypoglycemia in this group of people is a risk factor for cardiovascular events (eg sudden death, myocardial infarction, etc.). It causes deterioration of cognitive function and dementia, as well as deterioration of heart and kidney function.)” points out Mr. Antonios Lepouras MD, Specialist Pathologist-Diabetologist Director of Pathology-Diabetology Clinic & Diabetes Center Metropolitan General.

The importance of good glucose regulation

On the other hand, poor regulation with daily high sugar levels can cause serious deterioration in all parameters of their health. Preventing hypoglycemia and mitigating high glucose fluctuations can have significant positive effects on physical and cognitive function and general well-being. They can also improve or prevent chronic complications of diabetes.

New technologies for diabetes management

Over the past two decades there has been a significant increase in the adoption of diabetes treatment technology among children, adolescents and young adults with type 1 diabetes, and its use is now being advocated for older people as well. Technology for seniors includes:

• Wireless continuous glucose monitoring meters
• Systems with insulin pumps combined with wireless continuous glucose recording with alarm for low or very high sugar levels
• Fully automated insulin delivery systems (artificial pancreas)
• Smart wireless insulin pens (pens) connected to a glucose meter, which decide on its dose.

Prospects for the future

1. Continuous wireless recording meters

New technology continuous wireless recording meters (CGM-FGM) will probably in the near future replace the classic self-measurement with finger prick for those treated with insulin. The newest technological devices (CGM), some of which are now also provided by the insurance funds in our country, measure glucose per minute between the tissues under the skin, are wireless, giving information on glucose values ​​on the mobile phone, almost in real time time.
Their programming gives an audible alarm on the mobile phone for very low (80mg/dl) and very high glucose values ​​(200mg/dl), warning and protecting the user from hypoglycemia or very high sugar levels.

2. Artificial pancreas and insulin pumps

• Insulin pumps: Connected to a wireless continuous glucose meter. They stop insulin delivery when glucose values ​​fall below 80mg/dl, protecting against severe hypoglycemia.
• Artificial Pancreas: Advanced insulin pump that uses artificial intelligence (AID: Automated Insulin Delivery) to continuously monitor glucose and automatically adjust insulin delivery.

Technology and old age: Attention and personalization

The application of the technology to the elderly should be done with care and individualized selection of individuals, as there are several practical problems in its use, especially for older people. Advanced age, limited familiarity with digital technology, cognitive impairment and physical disabilities must be taken into account when implementing technological solutions. Additionally, factors such as reluctance or fear of adopting new technologies as well as the potential for personalized support/training should also be considered when designing technology interventions for this population.

Conclusions

Clinical trials and studies show that older people with diabetes benefit from technology in glucose management. Hypoglycemic episodes, emergency department visits, and hospital admissions are reduced, while their quality of life is improved. However, the particularities of aging may prevent the proper use of technology.

“Knowing glucose values ​​alone is not enough. Patients must be able to modify insulin doses, know how to treat hypoglycemia (ie blood sugar levels below 70mg/dl) and use rapid-acting mealtime insulin to correct blood sugar levels greater than 200mg/dl. It is essential to provide education to family members and caregivers of frail older adults with disabilities to support the use of technology for diabetes management.

The application of the technology should be done after a careful and comprehensive evaluation of each person. Treatment goals (whether stricter or more relaxed) must be determined jointly, taking into account many factors, such as the patient’s social context and living environment.

The cost of using the technology, as well as the social policies for the insurance coverage of this cost, are unfortunately still an obstacle to its wider use.

Elderly people with diabetes should not forget the importance of daily physical exercise (such as walking, yoga, etc.), socializing, as well as intellectual activity such as reading books and memory exercises (e.g. crossword, sudoku). These activities, combined with the use of new technology, can help them live a quality and long life” concludes Mr. Lepouras.