Older Age Associated with Improved Blood Glucose Control, Possible Correlation to Diet

Adjusting micronutrients can lower blood glucose in patients with T2D.

A 2018 Korean National Health and Nutrition Examination Survey (KNHANES) found that between 7.9% to 12.9% of adults thirty years or older had diabetes. Another study found that those who had diabetes for more than ten years had greater glycemic control than those with diabetes

for less than ten years (OR = 1.55, p < .05). The researchers of this study wanted to examine middle-aged and elderly individuals with T2D. They looked at the exercise, diet, body composition, and lab values of these participants to determine the effect it had on blood glucose levels. 

The study extracted information from 1,257 of 23,657 participants involved in the 2015–2017 KNHANES cross-sectional national survey. Inclusion criteria were age > 45 years and individuals who were taking diabetes medication or insulin. Exclusion criteria were an absence of diabetes, not taking diabetes medication or insulin, age <45 years old, pregnancy, daily calorie intake < 500 kcal or > 5000 kcal. Diabetic standing was sorted as either controlled or uncontrolled, depending on the fasting blood glucose cutoff of 126 mg/dL. Obesity was defined as ≥25 kg/m2, which was the cutoff for adults in the Asian and Pacific regions. Data on blood pressure, physical activity, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDLC), and triglycerides (TG) were also recorded. Researchers used stratified random sampling (kstrata), population sampling (psu), and weighted samples (wt_itvex) for presets to conduct multifaceted analysis in the SPSS Statistics program. The chi-square test was done on categorical variables, while linear regression modeling was used for continuous variables.

Out of those with diabetes, 527 had controlled, and 730 had uncontrolled blood glucose. Controlled blood glucose was significantly higher in individuals >64 years old (44.5%) compared to those of age 45-64 years old (44.5%). There was no significant difference in glycemic control regarding gender, residential living area, educational level, household income, employment status, smoking status, and alcohol consumption (p > .05). The study found no significant difference in obesity, hypertensive indicators, control rate of everyday walkers, control rate of people who do not walk, or control rate of people who walk 1–6 times a week (p > .05). 

There was a significantly higher mean BMI (25, 24.8), total cholesterol (170.4, 163.8), triglycerides (174.8, 144.7), intake of total energy (1735.6, 1699.5), fat (31.1, 30.4), saturated fatty acids (9.0, 8.7), and cholesterol (167.0, 156.4) in the uncontrolled group. The total amount of moderate-intensity activity during work, rest, and commuting in controlled patients was significantly higher (p < .001). The control rate of individuals performing a moderate-intensity activity for >240 minutes was significantly higher than that of patients with <240 minutes (p = .049). There was no significant difference in the consumption of monounsaturated fatty acids and n-3 fatty acids. Riboflavin in the uncontrolled group was significantly lower than that of the controlled group. The intake of calcium, phosphorus, potassium, riboflavin, niacin and vitamin C was significantly lower in the uncontrolled group, whereas the intake of vitamin A and carotene was significantly higher in the uncontrolled group.

According to this study, patients with uncontrolled blood glucose tended to be younger. The complexity of the disease might have hindered therapeutic progress for inexperienced individuals. Lifestyle changes such as weight loss, moderate-high intensity exercise, and a low-carbohydrate diet are crucial for managing diabetes. These changes are challenging to make, and there is an understandable adjustment period in which someone may slowly introduce these modifications. Researchers of this study found that diet played a significant role in managing T2D.  The total energy, fat, saturated fatty acid and cholesterol consumption was significantly higher in those with uncontrolled blood glucose. Several micronutrients were also found to be significantly higher or lower in the uncontrolled group. More education on these variables might improve the glycemic of younger patients. Limitations of the analysis include the cross-sectional study design and using only one blood glucose level.

Practice Pearls:

• Controlled blood glucose was significantly higher in individuals older than 64 years (44.5%) compared to those of age 45-64 years (44.5%).
• Mean BMI, intake of total energy, fat, saturated fatty acids, cholesterol, total cholesterol, and triglycerides was significantly higher with the uncontrolled blood glucose group.
• The intake of calcium, phosphorus, potassium, riboflavin, niacin and vitamin C was significantly lower in the uncontrolled blood glucose group, whereas the intake of vitamin A and carotene was significantly higher in the uncontrolled blood glucose group.

Comellas, Mariceli et al. “Age and glycemic control among adults with type 2 diabetes in the United States: An assessment from the National Health and Nutrition Examination Survey (NHANES) 2013-2014.” Diabetes & metabolic syndrome vol. 13,6 (2019): 3069-3073. doi:10.1016/j.dsx.2019.11.004. https://pubmed.ncbi.nlm.nih.gov/31765980/

Kim, Young Mi et al. “A Cross-Sectional Study of the Effects of Physical Activity and Nutrient Intakes on Blood Glucose Control Rates in Middle-Aged and Elderly Diabetes Patients: Korean National Health and Nutrition Examination Survey 2015-2017.” Inquiry: a journal of medical care organization, provision and financing vol. 58 (2021): 469580211035727. doi:10.1177/00469580211035727. https://pubmed.ncbi.nlm.nih.gov/34541956/

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions