Diabetes is becoming one of the most prevalent conditions among the elderly worldwide. Over the last several decades, the global incidence of the disease among people aged 65 years and above has significantly increased. In 2019, about 11.3% of the total population had diabetes with the elderly rates remaining high, at 29.2% (American Diabetes Association, 2022). Patients with diabetes are at risk of developing other conditions, especially cardiovascular complications. Along with a greater prevalence of diabetes mellitus comes an increased risk of vascular disease. These diseases affect microvasculature, arteries, and veins leading to complications that can be fatal to patients. Treatment approaches to diabetes among the elderly should involve glycemic control and management of vascular complications to increase the functional capacity of patients.
Tight glycemic control among elderly patients with diabetes can be an effective strategy to manage vascular complications compared to individuals whose glucose levels are not controlled.
Diabetes mellitus is not just a disease of carbohydrate metabolism, but also a cause of vascular disease that affects nearly all blood vessels. Vascular complications are classified as either microvascular or macrovascular depending on the type of blood vessels affected. Microvascular complications mainly include retinopathy, nephropathy, and neuropathy. On the other hand, macrovascular complications affect large blood vessels and include coronary artery, peripheral, and cerebral vascular disease. It is established that 13% of patients with diabetes develop retinopathy at five years and more than 90% have the complication after 10 to 15 years (Zimmerman, 2016). Approximately 30% of those with type 2 diabetes develop nephropathy which is the major cause of end-stage renal disease in these patients (Zimmerman, 2016). Regarding macrovascular complications, an estimated 37% to 42% of ischemic strokes in the US are related to the effects of diabetes.
Vascular complications of diabetes are caused by a wide range of factors including hyperglycemia, insulin resistance, and excess free fatty acid. There is also a close relationship between the occurrence of these complications with modifiable risk factors. For instance, tobacco use considerably increases the risk of onset and progression of vascular complications (Rask-Madsen & King, 2013). Hypertension, dyslipidemia, and family history of these conditions increase the risk of macrovascular disease. The clinical presentation of vascular complications depends on the type of disease observed and its location. For example, diabetic retinopathy is the leading cause of blindness in the United States(Rask-Madsen & King, 2013). Patients with nephropathy present with edema, arrhythmias, and other symptoms related to renal failure while those with neuropathy will experience calf pain, loss of ankle jerk reflexes, and muscle wasting.
Appropriate management of vascular complications of diabetes requires healthcare providers to focus on several areas. The providers must ensure adequate control of blood glucose levels, nutritional management, blood pressure control, and lifestyle modification (Yakaryılmaz & Öztürk, 2017). These management strategies target aspects like weight and saturated fats in the body that make it difficult to control blood glucose levels leading to vascular complications. Among the top emerging strategies that are supported by evidence to manage vascular complications in the elderly involve intensive glycemic control and aggressive control of hypertension. There is a close link between high baseline A1c (HbA1c) levels with increased incidence of retinopathy and other microvascular complications (Beckman & Creager, 2016). Likewise, control of hypertension with drugs like ACE inhibitors slows the development and progression of microvascular complications. While some patients might not have hypertension, adequate glycemic control can be an effective measure to manage vascular complications in the elderly.
The purpose of this discussion is to determine the effectiveness of tight glycemic control in managing vascular complications among elderly patients with diabetes.
Diabetes is a growing pandemic and a leading cause of morbidity and mortality in the country. As the general population continues to age, the elderly, aged 65 years and above with diabetes is also increasing. This population is more at risk of developing diabetes complications like kidney disease, hypoglycemia, heart disease, and vascular complications (Yakaryılmaz & Öztürk, 2017). Vascular complications are the most serious manifestations of diabetes that cause impaired life expectancy and fatal conditions like end-stage renal disease and blindness (Beckman & Creager, 2016). Despite the advances in diabetes management, vascular complications remain a threat to the elderly requiring more advanced options. While lifestyle modification and treatment lower the risk of other complications, intensive blood glucose lowering can serve to decrease the risk of microvascular and macrovascular complications.
Research questions help the researcher to focus their study by providing a path through the research and writing process. My research questions to guide the discussion of vascular disease management among the elderly are as follows:
- Among elderly patients with diabetes, how effective is intensive glycemic control in managing vascular complications?
This question will identify is intensive glycemic control has any effect on the development or delay in the manifestation of vascular complications among the elderly with diabetes.
- What is the most significant effect of intensive glycemic control in addressing vascular complications among the elderly?
This question will be used to answer the mechanism through which HbA1c control minimizes or prevents vascular complications in the affected population.
- What levels of HbA1c can be achieved to adequately prevent or slow the development of vascular complications among the elderly?
This question aims at determining the recommended HbA1c levels that should be achieved for the prevention of vascular disease among the elderly.
American Diabetes Association. (2022). Statistics: Statistics about diabetes. https://www.diabetes.org/about-us/statistics/about-diabetes#:~:text=Prevalence%20in%20seniors%3A%20The%20percentage,diagnosed%20with%20diabetes%20every%20year.
Beckman, J. A., & Creager, M. A. (2016). Vascular complications of diabetes. Circulation Research, 118(11), 1771-1785.
Rask-Madsen, C., & King, G. L. (2013). Vascular complications of diabetes: Mechanisms of injury and protective factors. Cell Metabolism, 17(1), 20–33. https://doi.org/10.1016/j.cmet.2012.11.012
Rodríguez-Gutiérrez, R., & Montori, V. M. (2016). Glycemic control for patients with type 2 diabetes mellitus: Our evolving faith in the face of evidence. Circulation. Cardiovascular Quality and Outcomes, 9(5), 504–512.
Yakaryılmaz, F. D., & Öztürk, Z. A. (2017). Treatment of type 2 diabetes mellitus in the elderly. World Journal of Diabetes, 8(6), 278–285.
Zimmerman, R. S. (2016). Diabetes mellitus: Management of microvascular and macrovascular complications. J Cleveland Clinic: Centers for Continuing Education. https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/diabetes-mellitus/
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