Elderly Men and Health Service Provision for Type 2 Diabetes Management: A Critical Analysis of Knowledge Gaps

Chronic long-standing type 2 diabetes and subsequent complications (comorbidities) represent a major clinical and public health challenge for elderly men from a prevention and management viewpoint. In the developed western countries, evidence suggests that 80% of premature deaths and disability due to diabetes and heart disease can be prevented. Diabetes care in the elderly include further challenges in management of comorbidities such as hypertension, the metabolic syndrome (MetS), kidney problems including nephropathy and chronic renal failure, vision abnormalities such as cataract and retinopathy. The comorbidities are subsequent to complex mechanistic processes incurred by the hyperglycemia and reduced insulin sensitivity in diabetes. Management of diabetic elderly patients with type 2 diabetes is further challenged by lack of specific clinical guidelines tailored to this population. Existing clinical guidelines are based on evidence from clinical trials conducted in younger (< 65 years of age) patients. There is a need for designing improved models of health care delivery, assessment of comorbidities and polypharmacy in elderly men, including mental health issues such as depression and dementia that may persist with diabetes. An integrated, comprehensive, and patient-oriented management care plan seems the best practice clinical approach to ensure that the risk of hypoglycemia does not increase while treating elderly diabetic men with existent multimorbidity