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How Should We Treat the Elderly with Diabetes?

Nov 16, 2012
More than one-quarter of all adults over age 65 have diabetes but there is little research on how to treat the disease in older adults….

Fewer studies on the best ways to treat elderly patients with diabetes has resulted in doctors lacking a strong understanding of how diabetes affects this population. The American Diabetes Association is hoping to change that.

The ADA recently convened a group of doctors and other experts to study the issue in greater depth. The fruit of their labor, a report titled "Diabetes in Older Adults: A Consensus Report," will be published later this year in Diabetes Care and The Journal of the American Geriatrics Society.

"This is a major effort to address this challenge," said Dr. Hermes Florez, a member of the committee and head of the division of epidemiology at the University of Miami Miller School of Medicine. "With life expectancy being five to 10 years more than before and the increased prevalence of this disease, we have to prepare ourselves."

According to the ADA research paper, the number of cases of diagnosed diabetes in the elderly is projected to more than quadruple by 2050. Why do older adults face such a high risk of developing diabetes?

According to the report, the body becomes more resistant to insulin with age. What’s more, the part of the pancreas that synthesizes insulin functions less effectively over time.

Florez, who is also the deputy director of the Geriatrics Research Education and Clinical Center within the Miami VA Healthcare System, stated that, "The mean age of the patients I see is about 80." "Some of them are quite functional and very proficient. Others are very frail."

Diabetes can cause a myriad of complications. The ADA report found that older adults who have diabetes are at a higher risk of limb amputations, heart attacks, vision problems and kidney failure than diabetes patients in any other age group. The risk grows even higher for patients over 75.

Additionally, older adults with diabetes are twice as likely as other older adults to have cognitive problems like Alzheimer’s disease and dementia, according to the paper. They face a higher risk of depression, hearing and vision problems, as well as falling. "That could be a devastating event leading to a hip fracture and a prolonged rehabilitation," Florez said.

Still, questions linger about how to treat diabetes in older patients, largely because little research has been done.

"The exclusion of older, and especially frail older, participants from most traditional randomized controlled trials of diabetes interventions has left us with large gaps in our knowledge of how best to address diabetes in the age-group with the highest prevalence rates," the research group wrote in its report.

Florez said older adults may have been left out of the clinical research because the pharmaceutical companies wanted to avoid possible complications. In addition, few geriatric specialists and researchers were trained to look out for diabetes, he said.

Once a diagnosis is made, treating diabetes in older adults can be a challenge. Older patients tend to eat less, so it is difficult to control the disease through diet modification. Treating the disease can be even more challenging for older adults living in a nursing home, where meals can be erratic and there are high levels of employee turnover.

Researchers are working on studies that will address some of those questions.

Presented at the 2012 AHA Meeting.