Perriello G. Audit. 27.11 - 18.00.pps

Società Italiana Gerontologia e Geriatria53° Congresso NazionaleGabriele PerrielloDipartimento di Medicina InternaUniversità di PerugiaTerapia Orale del Diabete tipo 2: nuove evidenze scientificheFirenze, 27 novembre 2008nznovembre Eterogeneity of T2DMβ-cellInsulinType 2Resistance DysfunctiondiabetesAdapted from: Beck-Nielson H et al. J Clin Invest 1994;94:1714–1721 and Saltiel AR, Olefsky JM. Diabetes 1996;45:1661–1669Clinical and FunctionalEterogeneity of Elderly T2DM1. Older individuals may have developed diabetes years earlier and may have significant complications2. Newly diagnosed may have had years of undiagnosed diabetes with resultant complications or may have few complications from the disease3. Older adults with diabetes may be frail and have other underlying chronic conditions, substantial diabetes-relatedcomorbidity, or limited physical or cognitive functioning4. Older individuals with diabetes have little comorbidity andare active5. Life expectancies are highly variable for this population,but often longer than clinicians realizeAmerican Diabetes Association: Standards of Medical Care in Diabetes—2008; Diabetes Care 31:S12-S54, 2008Algorithm for the metabolic management of type 2 diabetesetatypeADA/EASD Consensus StatementTier 1: Well-validated core therapiesLifestyle + MetforminLifestyle + MetforminAt diagnosis:+ +Basal insulinIntensive insulinLifestyle+Lifestyle + MetforminMetformin+aSulfonylureaSTEP 1 STEP ...