Therapeutic management of diabetes in the elderly with reference to the recommendations of the French Haute Autorite de la sante

Type 2 diabetes mellitus is a major public health problem in elderly people, where it still represents a risk factor for complications and death, as well as a cause of worsening of the quality of life. Its management is difficult, because of the necessary cooperation of the patient, which is not always possible, and because of the vulnerability of the elderly patient to iatrogenic complications, particularly hypoglycemia. So, it appears mandatory to adapt the therapeutic goals and strategies to every individual situation, as it is now recommended for all patients with type 2 diabetes by the ADA-EASD expert group. The French Haute Autorite de la sante (HAS) has recently published its recommendations for the glycemic management of type 2 diabetes with some special advises for the patients aged 75 and more. Healthy elderly people can benefit from the same therapeutic goals and means than younger patients, while it is necessary to have less strict objectives in frail patients. In very sick and dependent patients, quality of life is the major endpoint and the treatment of diabetes is essentially aimed to prevent major glycemic decompensations.