Hyperglycemia, dyslipidemia and hypertension in older people with diabetes: the benefits of cardiovascular risk reduction

Author(s): Siobhan HM Brown and Ahmed H Abdelhafiz

Diabetes mellitus is increasingly recognized as an essentially vascular disease, and a principal objective of diabetes care is prevention or reduction of cardiovascular risk. In this context, control of hyperglycemia, dyslipidemia and hypertension is at the heart of this care. As the combination of age and diabetes increases baseline vascular risk in older people, they stand to gain most from cardiovascular risk prevention. Although most of the clinical trials have excluded or included only few older people, there is now enough evidence to suggest that aggressive treatment of vascular risk factors in this age group is beneficial and could be cost effective. Current comprehensive mutifactorial risk reduction is suboptimal in older people with diabetes. Aggressive intervention is suitable in older people with diabetes who have reasonable life expectancy. Many older people with diabetes may not achieve recommended targets for risk factors reduction due to various reasons, including polypharmacy and comorbidities, but even a small reduction in these risk factors is beneficial. However, for frail older people with multiple disabilities, including cognitive and functional impairment, tight interventions may not be effective considering their short life expectancy and the risks associated with multiple medications, particularly hypoglycemia. Quality of life remains the primary target in the medical care of this group of patients.