Introduction
The prevalence of type II diabetes mellitus is anticipated to rise gradually with aging and decreased life expectancy. Among older adults, there are numerous unanswered questions regarding the management of diabetes mellitus, and this calls for individualized treatment (Marín-Peñalver et al., 2016). Comorbidity and functional restrictions of people with type 2 diabetes mellitus should be considered when setting treatment goals.
Evidence-Based Guidelines
Since the patient is an older adult, she will benefit from the management of the symptoms of high blood sugar, which encompass incontinency and frequent urination. Over and above medication, lifestyle modification is helpful (Yakaryılmaz & Öztürk, 2017). I would encourage the patient to adhere to regular exercise and healthy nutrition. Since there is no single approach that suits everyone, through an informed discussion, the patient should be involved in the management of blood sugar and underlying risks.
Medication
Metformin and Glipizide are the medications that I would prescribe to the patient. Metformin has the benefit of reducing the production of hepatic glucose through the suppression of gluconeogenesis. Positive outcomes on cardiovascular diseases, low cost, and minimal risk of hypoglycemia result in Metformin and Glipizide being the best choices for the patient (Jyothi & Himabindu, 2017). Additionally, the ability of these medications to manage high blood sugar assists in the prevention of kidney failure, eyesight problems, and sexual dysfunction to mention a few.
Expectation
I would anticipate the HbA1c to drop by three points in 3 months on the next visit. For older adults such as this patient who have minimal chronic illnesses and healthy cognitive function, the recommended HbA1c level is <7.5%. For other individuals who do not have diabetes, the normal level of HbA1c is from 4% to 5% (Yakaryılmaz & Öztürk, 2017). HbA1c level of about 5.7% to 6.4% signifies a high possibility of becoming diabetic while 6.5% and above indicates that one has diabetes.
Side Effects
The possible side effects for both Metformin and Glipizide include nausea, flatulence, vomiting, lactic acidosis, and diarrhea. These side effects are, however, common with people who have recently started taking the medications (Jyothi & Himabindu, 2017). Such problems are expected to disappear over time. In a situation where the side effects continue for a long time, there is a need to seek further medical advice and examination, which could necessitate their withdrawal or a reduction of dosage.
Education
I would inform the patient that continued administration of Metformin requires the attention of health professionals in situations where eGFR drops to 30 mL/min or lower. If a patient has an eGFR of between 30 and 45 mL/min, there is a need to characteristically decrease the dosage by half (to about 500 mg each day). Poor nutrition, especially insufficient protein intake, may raise the risk of feebleness and sarcopenia (Yakaryılmaz & Öztürk, 2017). Healthy nutrition should be coupled with an exercise program for positive outcomes. Medication should be administered with caution since older adults have a high possibility of developing other conditions such as kidney problems, stroke, pneumonia, and cardiac failure to mention a few.
Conclusion
There are some complications concerning the management of type 2 diabetes mellitus in older patients, which necessitate individualized treatment. Comorbidity and functional constraints of patients with type 2 diabetes mellitus should be mulled over when setting treatment objectives. The best medications for prescribing to older adults with type 2 diabetes are Metformin and Glipizide.
References
Jyothi, K., & Himabindu, G. (2017). Comparison of efficacy and adverse effect of Gliclazide, Metformin and Glipizide, Metformin combinations on type 2 diabetes patients. Indian Journal of Research in Pharmacy and Biotechnology, 5(2), 129-133.
Marín-Peñalver, J. J., Martín-Timón, I., Sevillano-Collantes, C., & del Cañizo-Gómez, F. J. (2016). Update on the treatment of type 2 diabetes mellitus. World Journal of Diabetes, 7(17), 354-360. Web.
Yakaryılmaz, F. D., & Öztürk, Z. A. (2017). Treatment of type 2 diabetes mellitus in the elderly. World Journal of Diabetes, 8(6), 278-285. Web.