Skip to main content
SpringerLink
Log in

Diabetes mellitus im Alter

Teil 2: nichtmedikamentöse Therapie, typische Begleiterkrankungen und ihre Konsequenzen

Diabetes mellitus in the elderly

Part 2: non-medicinal therapy, typical comorbidities and sequelae

  • CME Zertifizierte Fortbildung
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Bei Diabetes mellitus sind auch im hohen Lebensalter eine moderate körperliche Bewegung (soweit diese funktionell möglich ist) und eine Ernährung mit ausgewogener Mischkost zur Optimierung der Stoffwechseleinstellung vorteilhaft. Der anzustrebende Body-Mass-Index liegt bei über 65-Jährigen zwischen 24 und 29 kg/m2, denn Gewichtsverlust geht bei älteren Menschen mit und ohne Diabetes mit einer erhöhten Sterblichkeit einher. Ist eine Insulineinstellung indiziert, müssen psychologische Barrieren der Insulintherapie älterer Menschen berücksichtigt werden, wie z. B. die Injektionsangst oder die Furcht vor Stigmatisierung durch die Insulintherapie. Geriatrietypische Begleiterkrankungen wie z. B. kognitive Störungen und Depressionen sind häufige Komorbiditäten neben dem Diabetes und müssen entsprechend behandelt werden. Dabei ist die Einbeziehung von Angehörigen und/oder Pflegekräften meist vorteilhaft. Auch Besonderheiten bei kardiovaskulären und zerebralen Akutereignissen im höheren Lebensalter werden im vorliegenden Beitrag dargestellt.

Abstract

In elderly persons with diabetes mellitus moderate physical exercise (as far as functionally possible) and a balanced diet are advantageous for optimization of metabolic adjustment. The optimal body-mass index for elderly persons over 65 years old lies between 24 kg/m2 and 29 kg/m2 as weight loss in elderly persons with and without diabetes is associated with increased mortality. If insulin adjustment is indicated the psychological barriers of insulin therapy in the elderly must also be considered, such as fear of injections or fear of stigmatization due to insulin therapy. Typical geriatric comorbidities, such as cognitive disorders and depression are often present in addition to diabetes and must be treated accordingly. In this situation the inclusion of relatives or nursing staff is mostly advantageous. In this article the characteristics of cardiovascular and cerebral acute events in the elderly will also be presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Zeyfang A, Bahrmann A, Wernecke J (2011) Diabetes mellitus im Alter. Praxisleitlinie der Deutschen Diabetesgesellschaft. Diabetologie 6(Suppl. 2):170–175

    Google Scholar 

  2. Hader C, Beischer W, Braun A et al (2004) Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Alter. In: Scherbaum WA, Kiess W (Hrsg) Evidenzbasierte Diabetes-Leitlinie der Deutschen Diabetesgesellschaft (DDG). Diabetes Stoffwechs 13(Suppl. 2):31–56

  3. Mann J, De Leeuw I, Hermansen K et al (2005) Evidenz-basierte Ernährungsempfehlungen zur Behandlung und Prävention des Diabetes mellitus. Diabetes Stoffwechs 14(Suppl):75–94

    Google Scholar 

  4. Fiatarone MA, O’Neill EF, Ryan ND et al (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 330:1769–1775

    Article  PubMed  CAS  Google Scholar 

  5. Flicker L, McCaul KA, Hankey GJ et al (2010) Body mass index and survival in men and women aged 70–75. J Am Geriatr Soc 58:234–241

    Article  PubMed  Google Scholar 

  6. Erickson KI, Raji CA, Lopez OL et al (2010) Physical activity predicts gray matter volume in late adulthood: the Cardiovascular Health Study. Neurology 75:1415–1422

    Article  PubMed  CAS  Google Scholar 

  7. Ibanez J, Gorostiaga EM, Alonso AM et al (2008) Lower muscle strength gains in older men with type 2 diabetes after resistance training. J Diabetes Complicat 22:112–118

    Article  PubMed  Google Scholar 

  8. Leyk D, Ruther T, Wunderlich M et al (2010) Physical performance in middle age and old age: good news for our sedentary and aging society. Dtsch Arztebl Int 107:809–816

    PubMed  Google Scholar 

  9. Petrak F (2006) Psychologische Barrieren der Insulintherapie bei Patienten mit Typ-2-Diabetes. Diabetes Stoffwechs Herz (Suppl. 1):3–9

  10. Peyrot, M, Rubin RR, Lauritzen T et al (2006) Patient and provider perceptions of care for diabetes: results of the cross-national DAWN study. Diabetologia 49:279–288

    Article  PubMed  CAS  Google Scholar 

  11. Abel A, Bahrmann A, Petrak F et al (2011) Psychologische Insulinresistenz bei geriatrischen Patienten mit Diabetes mellitus. Med Klinik (Suppl 1) (Poster)

  12. Zeyfang A, Bahrmann A, König C et al (2010) Technologie im Dienste des Älteren. Diabetologe 6:570–576

    Article  Google Scholar 

  13. Wannamethe SG, Shaper AG, Whincup PH et al (2011) Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med 171:404–410

    Article  Google Scholar 

  14. Malmberg K, Yusuf S, Gerstein HC et al (2000) Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) registry. Circulation 102:1014–1019

    Article  PubMed  CAS  Google Scholar 

  15. Bahrmann A, Bahrmann P, Zeyfang A et al (2011) Diabetes and cardiovascular diseases in old age. Z Gerontol Geriatr 44:172–176

    Article  PubMed  CAS  Google Scholar 

  16. Beckett NS, Peters R, Fletcher AE et al (2008) Treatment of hypertension in patients 80 years of age or older. N Engl J Med 358:1887–1898

    Article  PubMed  CAS  Google Scholar 

  17. Gaede P, Lund-Andersen H, Parving HH et al (2008) Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 358:580–591

    Article  PubMed  CAS  Google Scholar 

  18. Foody JM, Rathore SS, Galusha D et al (2006) Hydroxymethylglutaryl-CoA reductase inhibitors in older persons with acute myocardial infarction: evidence for an age-statin interaction. J Am Geriatr Soc 54:421–430

    Article  PubMed  Google Scholar 

  19. Behrens M, Dörr R, Eckert S et al (2010) Diabetes mellitus und Herz. Diabetologie 5:122–126

    Article  Google Scholar 

  20. Fuster V, Ryden LE, Cannom DS et al (2006) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace 8:651–745

    Article  PubMed  Google Scholar 

  21. Ford GA, Ahmed N, Azevedo E et al (2010) Intravenous alteplase for stroke in those older than 80 years old. Stroke 41:2568–2574

    Article  PubMed  Google Scholar 

  22. Norhammar A, Malmberg K, Diderholm E et al (2004) Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization. J Am Coll Cardiol 43:585–591

    Article  PubMed  Google Scholar 

  23. Rittger H, Hochadel M, Behrens S et al (2012) Age-related differences in diagnosis, treatment and outcome of acute coronary syndromes: results from the German ALKK registry. EuroIntervention 7:1197–1205

    Article  PubMed  Google Scholar 

  24. Schoenenberger AW, Radovanovic D, Stauffer JC et al (2008) Age-related differences in the use of guideline-recommended medical and interventional therapies for acute coronary syndromes: a cohort study. J Am Geriatr Soc 56:510–516

    Article  PubMed  Google Scholar 

  25. Braun A, Muller UA, Muller R et al (2004) Structured treatment and teaching of patients with type 2 diabetes mellitus and impaired cognitive function – the DICOF trial. Diabet Med 21:999–1006

    Article  PubMed  CAS  Google Scholar 

  26. Kopf D, Frölich L (2009) Risk of incident Alzheimer’s disease in diabetic patients: a systematic review of prospective trials. J Alzheimers Dis 16:677–685

    PubMed  Google Scholar 

  27. Whitmer RA, Karter AJ, Yaffe K et al (2009) Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 301:1565–1572

    Article  PubMed  CAS  Google Scholar 

  28. Bruce DG, Davis WA, Casey GP et al (2009) Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study. Diabetologia 52:1808–1815

    Article  PubMed  CAS  Google Scholar 

  29. Knol MJ, Twisk JW, Beekman AT et al (2006) Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia 49:837–845

    Article  PubMed  CAS  Google Scholar 

  30. Mezuk B, Eaton WW, Albrecht S et al (2008) Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 31:2383–2390

    Article  PubMed  Google Scholar 

  31. Hermanns N, Kulzer B, Krichbaum M et al (2005) Affective and anxiety disorders in a German sample of diabetic patients: prevalence, comorbidity and risk factors. Diabet Med 22:293–300

    Article  PubMed  CAS  Google Scholar 

  32. Gonzalez JS, Peyrot M, McCarl LA et al (2008) Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 31:2398–2403

    Article  PubMed  Google Scholar 

  33. Black SA, Markides KS, Ray LA (2003) Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 26:2822–2828

    Article  PubMed  Google Scholar 

  34. Riederer P, Bartl J, Laux G et al (2011) Diabetes type II: a risk factor for depression, Parkinson, Alzheimer? Neurotox Res 19:253–265

    Article  PubMed  Google Scholar 

  35. Hauner H, Kurnaz AA, Haasert B et al (2001) Undiagnosed diabetes mellitus and metabolic control assessed by HbA1c among residents of nursing homes. Exp Clin Endocrinol Diabetes 109:326–329

    Article  PubMed  CAS  Google Scholar 

  36. Lederle M, Ettlinger G, Schäfer T (2008) Situation von pflegebedürftigen Diabetikern in Pflegeeinrichtungen im Kreis Borken. Diabetes Stoffwechs Herz 3:169–176

    Google Scholar 

  37. Zeyfang A, Dippel FW, Bahrmann A et al (2010) Aktuelle Versorgungssituation und Ressourcenbedarf bei insulinpflichtigen Typ-2-Diabetikern in ambulanter und stationärer Pflege: Ergebnisse der LIVE-GERI Studie. Diabetes Stoffwechs 23:293–300

    Article  Google Scholar 

  38. Bahrmann A, Abel A, Specht-Leible N et al (2010) Treatment quality in geriatric patients with diabetes mellitus in various home environments. Z Gerontol Geriatr 43:386–392

    Article  PubMed  CAS  Google Scholar 

  39. Bahrmann A, Wörz E, Specht-Leible N et al (2011) Behandlungsqualität und Inzidenz schwerer Hypoglykämien bei geriatrischen Patienten mit Diabetes mellitus im Pflegeheim. Med Klinik (DGIM Poster) PS 143

  40. Holstein A, Patzer OM, Machalke K et al (2012) Substantial increase in incidence of severe hypoglycemia between 1997–2000 and 2007–2010: a German longitudinal population-based study. Diabetes Care 35:972–975

    Article  PubMed  Google Scholar 

  41. http://www.pflegewissen.de/, 2012. Zugegriffen: 28. Mai 2012

Download references

Interessenkonflikt

Die korrespondierende Autorin weist für sich und ihre Koautoren auf folgende Beziehungen hin: Vortragstätigkeiten für Berlin-Chemie AG, Novartis, Lilly GmbH.

Author information

Authors and Affiliations

  1. Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland

    A. Bahrmann

  2. AGAPLESION Diakonieklinikum Hamburg, Hamburg, Deutschland

    J. Wernecke

  3. Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland

    P. Bahrmann

  4. Marien-Krankenhaus Hamburg, Hamburg, Deutschland

    D. Kopf

  5. AGAPLESION Bethesda Krankenhaus Stuttgart, Stuttgart, Deutschland

    A. Zeyfang

Authors
  1. A. Bahrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Wernecke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Bahrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Kopf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Zeyfang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Bahrmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bahrmann, A., Wernecke, J., Bahrmann, P. et al. Diabetes mellitus im Alter. Diabetologe 8, 665–675 (2012). https://doi.org/10.1007/s11428-012-0979-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11428-012-0979-x

Schlüsselwörter

Keywords

Search

Navigation