Diabetes Mellitus, a Multidisciplinary Approach

Diabetes mellitus is a disease with a high prevalence in the general population, especially in geriatric patients due to the changes in pancreatic function associated with ageing.

It affects up to 30% of the population over 75 years of age, and in approximately 10% it can exist silently. Its presence has a high relationship with the increase in cardiovascular risk and should be considered differently from the diabetic who ages with a high risk of micro- and macro-angiopathic complications, to whom the disease debuts with a shorter life expectancy, although many of the complications have been occurring for years prior to diagnosis.

Diabetic retinopathy is a relevant cause of blindness and neuropathic alterations can cause chronic pain, greatly affecting the quality of life of the individual. There is a clear relationship between the presence of diabetes with cognitive impairment and depressive disorders, fragility, malnutrition, as well as an increase in complications and hospital stay in those patients with poorer metabolic control.

Collaboration between different scientific societies has culminated in the development of a treatment protocol for type 2 diabetes mellitus (1), which takes into account the heterogeneity of elderly patients, emphasising people-centred objectives rather than the disease, adapting interventions to care objectives according to functional capacity, life expectancy and present comorbidities. It is important to make a tailor-made suit for the patient and not only taking into account clinical practice guidelines.

This shared effort should be the beginning of a closer collaboration among clinicians, to give real expression to multidisciplinary care, establishing the management of the different chronic pathologies to the peculiarities of the elderly patient, with their different comorbidities and associated treatments.

The recommendations of the groups of experts in chronic pathologies (arterial hypertension, dyslipemias, diabetes) progressively decrease the levels of different biological parameters, thus producing the so-called silent epidemics, increasing the prevalence of the different risk factors in the community. Intervention measures on cardiovascular risk, defined as the probability of the appearance of a cardiovascular event at 10 years, imply an increasingly interventionist attitude, with the safety problems that it entails, especially in those people with a shorter life expectancy, and being scarcely included in clinical trials.

For all these reasons, it is important to have a multidisciplinary and consensual tool, setting objectives in accordance with the classification of geriatric patients and emphasising aspects such as functionality and life expectancy.

"It is not enough to achieve wisdom, it is necessary to know how to use it.
Ciceron (106-43 BC)

(1) Gomez Huelgas R, Diez- espino J, Formiga F and col. Treatment of type 2 diabetes in the elderly patient. Med Clin 2013;140(3): 134e1-e12.