Skip to main content
SpringerLink
Log in
Book cover

Principles of Diabetes Mellitus pp 1–9Cite as

Diabetes in the Elderly

  • Living reference work entry
  • First Online:

Abstract

Diabetic phenotypes in the elderly are extremely diverse. The many different manifestations of hyperglycemia in this population in part result from a dichotomy of patients. Some patients present at an earlier age and progress through their life with diabetes. This group exhibits higher burden of complications which contribute to geriatric syndromes, thus demonstrating how the complications of diabetes promote accelerated aging. Other patients develop diabetes at a later age and can thus be viewed as examples of aging itself being a risk factor for loss of glycemic control. The management of diabetes in the elderly, as with younger patients, involves lifestyle changes, education, and monitoring, as well as multiple classes of medications. The goals of therapy in the elderly need to be individualized based on many factors. The prime directive of “do no harm” in the elderly is vital, particularly in regard to avoidance of hypoglycemia.

This is a preview of subscription content, log in via an institution.

References

  1. Centers for Disease Control and Prevention. Public Health and aging, trends in aging – United States and worldwide. JAMA. 2003;289:1371–3.

    Article  Google Scholar 

  2. Selvin E, Coresh J, et al. The burden and treatment of diabetes in elderly individuals in the US. Diabetes Care. 2006;29:2415–9.

    Article  PubMed  Google Scholar 

  3. Hillegas WB, Patel MR, et al. Long term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the national cardiovascular data registry: 2004–2008. JACC. 2012;60:2280–9.

    Article  Google Scholar 

  4. Shirley S, Travis RJ, et al. Analysis of nursing home residents with diabetes at admission. J Am Med Dir Assoc. 2004;5:320–7.

    Article  Google Scholar 

  5. Zhang X, Decker FH, et al. Trends in the prevalence of and comorbidities of diabetes mellitus in nursing home residents in the United States 1995–2004. J Am Geriatr Soc. 2010;58:724–30.

    Article  PubMed  Google Scholar 

  6. Kalyani RR, Egan JM. Diabetes and altered glucose metabolism with aging. Endocrinol Metab Clin N Am. 2013;42:333–47.

    Article  CAS  Google Scholar 

  7. Peterson KF, Befroy D, et al. Mitochondrial dysfunction in the elderly. Possible role in insulin resistance. Science. 2003;300:1140–2.

    Article  Google Scholar 

  8. Park SW, Goodpaster BH, et al. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging and body composition study. Diabetes. 2006;55:1813–8.

    Article  CAS  PubMed  Google Scholar 

  9. Park M, Keaton WJ, et al. Depression and risk of mortality in individuals with diabetes: a meta analysis and systematic review. Gen Hosp Psychiatry. 2013;35:217–25.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Clark NG, et al. Consensus development conference on antipsychotic drugs and obesity and diabetes Diabetes Care 2004;27:596–601.

    Google Scholar 

  11. Rawlings AM, Sharett AR, et al. Diabetes in midlife and cognitive change over 20 years. Ann Int Med. 2014;161:783–93.

    Article  Google Scholar 

  12. Kiyohara Y, et al. Glucose tolerance and risk of dementia in the community. The Hisayama study. Neurology. 2011;77:1126–34.

    Article  PubMed  Google Scholar 

  13. Lu F, et al. Diabetes and the risk of multisystem aging phenotypes: a systematic review and meta-analysis. PLoS ONE. 2009;4(1):e4144.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Figaro MK, et al. Diabetes, inflammation, and functional decline in older adults. Findings from the health, aging, and body composition study. Diab Care 2006;29:2039–2045.

    Google Scholar 

  15. Crane PK, Walker R, et al. Glucose levels and the risk of dementia. NEJM. 2013;369:540–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Munshi M, Capelson R. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care. 2006;29:1794–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gerstein HC. The action to control cardiovascular risk in diabetes study group. N Engl J Med. 2008;358:2545–59.

    Article  CAS  PubMed  Google Scholar 

  18. Ziegler D, Rathmann W, et al. Prevalence and risk factors of neuropathic pain in survivors of myocardial infarction in patients with diabetes and pre diabetes. The KORA Myocardial infarction registry. Eur J Pain. 2009;13:582–7.

    Article  PubMed  Google Scholar 

  19. Ness J, Aronow WS. Risk factors for coronary artery disease in old persons in an academic hospital based practice. Coron Artery Dis. 2000;11:437–9.

    Article  CAS  PubMed  Google Scholar 

  20. Hemmingsen B, Lund SS, Gluud C et al. (Targeting intensive glycemic control versus targeting conventional glycemic control for type 2 diabetes mellitus Cochrane Database Syst Rev 2011 Jun 15; issue 6.

    Google Scholar 

  21. Kelly TN. Systematic review: glucose control and cardiovascular disease. Ann Int Med. 2009;151:394–403.

    Article  PubMed  Google Scholar 

  22. Currie CJ, Peters JR. Survival as a function of hgb A1c in persons with type 2 diabetes: a retrospective cohort study. Lancet. 2010;375:481–9.

    Article  CAS  PubMed  Google Scholar 

  23. California Health Care Foundation. Guidelines for improving the health care of the older person. J Am Geriatr Soc. 2003;51:S265–80.

    Article  Google Scholar 

  24. Rockwood K, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  25. American Diabetes Association Standards of medical care in diabetes. Diab Care 2013: 36; (S1):11–65.

    Google Scholar 

  26. Knowler WC, Barrett-Connor E, et al. Reduction in the incidence of type 2 diabetes with lifestyle or metformin. Diabetes prevention program. N Engl J Med. 2002;346:393–403.

    Article  CAS  PubMed  Google Scholar 

  27. Flicker L, et al. Body Mass index and survival in men and women age 70–75. J Am Geriatr Soc. 2010;58:234–41.

    Article  PubMed  Google Scholar 

  28. Stressman J, Jacobs JM, et al. Normal BMI rather than obesity predicts greater mortality in elderly people: the Jerusalem Longitudinal Study. J Am Geriatr Soc. 2009;57:2232–8.

    Article  Google Scholar 

  29. Green JB, Bethel MA, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373:232–42.

    Article  CAS  PubMed  Google Scholar 

  30. Scirico BM, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369:1317–26.

    Article  Google Scholar 

  31. Bentley-lewis R, et al. Evaluation of LIXisenatide in acute coronary syndrome, a long term cardiovascular end point trial of lixisenatide versus placebo. Am Heart J. 2015;169:631–8.

    Article  CAS  PubMed  Google Scholar 

  32. Zinaman, Wanner C, et al. Empagliflozin, cardiovascular outcomes, and mortality in Type 2 diabetes. N Engl J Med. 2015;373:2117–28.

    Article  Google Scholar 

  33. Lee SJ. Diabetes performance measures in individuals with limited lifespan. J Am Geriatr Soc. 2012;60:361–2. showed that glargine insulin in pts mean age 69 achieved A1c goals without excess hypoglycemia.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Stahn A, Pistroch F, et al. Relationship between hypoglycemic episodes and ventricular arrhythmias in patients with type 2 diabetes and cardiovascular diseases: silent hypoglycemias and silent arrhythmias. Diabetes Care. 2014;37:516–20.

    Article  CAS  PubMed  Google Scholar 

  35. Beom W, Kim JM, et al. Corrected QT interval prolongation during severe hypoglycemia without hypokalemia in patients with type 2 diabetes. Diabetes Metab J. 2013;37:516–20.

    Article  Google Scholar 

  36. The Medical Letter. What comes after metformin for type 2 diabetes. Med Lett Drug Thera 2012;54:58–9.

    Google Scholar 

  37. Sussman JB, et al. Rates of deintensification of blood pressure and glycemic medicine treatment based on levels of control and life expectancy in older patients with diabetes mellitus. JAMA Intern Med. 2015;175:1942–9.

    Article  PubMed  Google Scholar 

  38. Vlassara H, Striker G. Advanced glycation endproducts in diabetes and diabetic complications. Endocrinol Metab Clin N Am. 2013;42:697–719.

    Article  Google Scholar 

  39. Price NL, et al. SIRT1 is required for AMPK activation and the beneficial effects of resveratrol on mitochondrial function. Cell Metab. 2012;15:566–7.

    Article  Google Scholar 

  40. Hughes JW, Herold KC. Novel SIRT1 mutation linked to autoimmune diabetes in humans. Cell Metab. 2013;17:448–55.

    Article  Google Scholar 

  41. IDF working group. Managing older patients with type 2 diabetes. Global guideline 2015.

    Google Scholar 

  42. US department of Veterans Affairs. Management of diabetes mellitus in primary care.2010. VA/DoD clinical guideline.

    Google Scholar 

  43. Kirkman MS, et al. Diabetes in older adults. Diabetes Care. 2012;35:2650–4.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MD Mount Sinai School of Medicine, New York, NY, USA

    Vincent Yen

Authors
  1. Vincent Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vincent Yen .

Editor information

Editors and Affiliations

  1. Lenox Hill Hospital Division of Endocrinology, New York, New York, USA

    Leonid Poretsky

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this entry

Cite this entry

Yen, V. (2016). Diabetes in the Elderly. In: Poretsky, L. (eds) Principles of Diabetes Mellitus. Springer, Cham. https://doi.org/10.1007/978-3-319-20797-1_53-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-20797-1_53-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-20797-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation