Typ-1-Diabetes mellitus im Alter, Wie gelingt eine sichere Insulintherapie im höheren Alter?

Thanks to 100 years of insulin therapy, people with type 1 diabetes mellitus (T1DM) can live to an old age but complications, comorbidities and age-associated syndromes and functional disorders remain challenges. A T1DM usually manifests in adolescence but can also appear for the first time in very old age, which is why the diagnosis of late autoimmune diabetes of adults (LADA) should be considered in appropriate clinical settings. As people age geriatric syndromes often emerge, which complicate the self-management of diabetes. Cognitive deficits, dementia and depression can significantly impair adherence to treatment and have a reciprocal relationship with diabetes. These geriatric syndromes can lead to poorer metabolic control, an increased risk of hypoglycemia and hyperglycemia and a reduced quality of life. The therapeutic goals should be regularly reviewed and individually adjusted in older age. As self-sufficiency declines family members or caregivers can undertake parts of the treatment. Technical aids, such as continuous glucose monitoring systems, insulin pumps and digital diaries provide additional support. Smart assistants and telemedicine enhance the quality of life and safety of those affected. A geriatric assessment helps to evaluate the ability for self-management and a timely planning of support. A close cooperation between patients, family members and the professional treatment team is essential to ensure adequate and flexible diabetes management in old age. The development of aids and technological solutions plays a crucial role in maintaining the independence and quality of life of older people with T1DM.