Diabetes is reaching epidemic proportions and, as societies age, physicians are treating growing numbers of elderly patients. We explored perceptions of diabetes in younger vs elderly patients among physicians who care for them on a daily basis.
We conducted a 20-minute online survey in Brazil, Japan, India, Spain, UK and USA, enrolling 652 adult T2DM patients and 337 physicians (264 general practitioners [GPs] and 73 specialists). Physicians were required to treat a minimum number of patients (GPs >50; specialists >100) and to spend at least 70% of their time per month in direct patient care.
Despite anticipating that only 14% of elderly (>80 years) and 36% of younger (>50 years) patients would comply with diet and exercise, physicians prescribed initial lifestyle intervention alone to similar proportions of these patients (25% vs 27%, respectively). Second-line therapies (after metformin) were also evenly distributed, independent of age, among DPP-4 inhibitors (17% and 18%, respectively) and sulphonylureas (11% and 15%, respectively). Physicians expected only around one-third of >80-year-olds and half of >50-year-olds to take their medications as prescribed; the most common reasons being forgetfulness (85%) and polypharmacy (72%) in the elderly, and dislike for medications (63%) in younger patients. Adverse effects were listed by physicians as a barrier to adherence in both age groups (56% in >80 years and 36% in >50 years); hypoglycaemia triggered a switch in medication in 52% of >80-year-olds and 41% of >50-year-olds. Physicians expected approximately half of patients to achieve target HbA1c, independent of age (44% in >80 years and 52% in >50 years).
In conclusion, physicians believe that elderly patients with T2DM are less likely to adhere to lifestyle changes or pharmacotherapy than younger patients, but nevertheless implement age-independent disease management strategies. Prospective work is required to verify these low expectations, and the appropriateness of current glycaemic targets and treatment algorithms for older adults.