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Diabetes Dateline

Diabetes and Aging
More people are living into their seventies, eighties, and nineties, and diabetes is on the upswing in this population. As is the case in younger groups, type 2 diabetes is sometimes preventable, but certain group-specific characteristics present new challenges to health care professionals treating older people with diabetes.

How many older people have diabetes?
More than half of the 16 million Americans estimated to have diabetes are over age 60. Of those over age 65, almost 1 in 5 has diabetes, mostly type 2. In groups at increased risk of type 2 diabetes, the proportion is even higher: Almost 1 in 3 older Hispanics and African Americans and 3 out of 4 Pima Indian elders have diabetes.

What is different for older people with diabetes?
The way diabetes is managed changes with age. Insulin production decreases because of the age-related impairment of pancreatic beta cells. Insulin resistance increases due to the loss of lean tissue and the accumulation of fat, particularly intra-abdominal fat, and the decreased tissue sensitivity to insulin.

In addition, other factors can affect diabetes management in older people:
Modifying lifestyle risk factors associated with type 2 diabetes, such as obesity, poor diet, smoking, and lack of exercise, may be more difficult for older people. Lack of means and access may restrict nutritional improvement, the decline in physical abilities may make exercise difficult, and years of smoking may make quitting very difficult.

Coexisting conditions, such as hypertension, increase the challenge of treating diabetes in older people. Further, diabetes can exacerbate the symptoms of coexisting conditions. Taking various medications for multiple conditions, called polypharmacy, increases the risk of adverse drug interactions. Diabetes complications can develop quickly in older people, often as a result of the long period before diagnosis. In addition, older people may have more complications, which may be more severe, than younger people.

Decreased physical and/or mental abilities may make it difficult to follow a treatment regimen. Limited financial resources may affect the choice and use of medication.

What are the treatment goals for older people with diabetes?
The treatment goals are the same for everyone who has diabetes--to enhance quality of life and reduce diabetes complications. Older people with diabetes are a heterogeneous group, encompassing those who are active and healthy as well as people who are frail and disabled. Researchers and clinicians agree that treatment goals need to be individualized and take into account health status, as well as life expectancy, level of dependence, and willingness to adhere to a treatment regimen. Nutrition therapy is usually a good starting point. Most patients can be advised to adopt some form of regular exercise and to take oral agents. Many will also be able to inject insulin, but intensive management may not be possible or advisable.

What is NIDDK doing to study diabetes in older people?
NIDDK supports research into the mechanisms and effects of type 2 diabetes in older people at both the scientific and clinical levels. Scientific research topics include insulin signal transduction and changes in insulin receptors.

If consistent with the study method, clinical trials are being designed to include more older people with diabetes. The Diabetes Prevention Program was designed to evaluate the efficacy of a lifestyle intervention and a pharmacological intervention in preventing or delaying type 2 diabetes in people with impaired glucose tolerance, a risk factor for type 2 diabetes. Of the 3,234 participants, 20 percent were over age 60.

For older adults at high risk, the study showed that modifying lifestyle with a low-calorie, low-fat diet and moderate regular exercise can delay the onset of type 2 diabetes.

Where can I get information about exercise and older adults?
The National Institute on Aging (NIA), part of the National Institutes of Health, has educational materials on exercise for older adults. Exercise: A Guide From the National Institute on Aging is a free, science-based guide to safe, effective exercise programs for older adults. It is also available in Spanish.

To obtain a copy of the award-winning guidebook, as well as other materials, contact the NIA Information Center at 1-800-222-2225 or visit the NIA website at www.nih.gov/nia.
NDIC Booklet Provides General Guide to Diabetes

Your guide to diabetes: type 1 and type 2, now available from NDIC, describes what diabetes is and how to take care of it. Written at an eighth-grade reading level, the illustrated publication summarizes steps for daily care, procedures to follow when blood glucose levels are high or low, how to prevent or delay long-term complications, management of diabetes during special times (during sick days, travel, school or work, or pregnancy), and additional resources.

This publication, an update of the NDIC booklet Do Your Level Best, provides target levels for the A1C test and daily blood glucose self-monitoring and a reproducible "daily diabetes record page" for recording blood glucose readings, medication dosages and times, and special events. The latest recommendations for target blood pressure and cholesterol levels are also included.

Use the online catalog to order a printed copy.

Courtesy of National Diabetes Information Clearinghouse