Purpose of Review
Due to treatment advancements, individuals with type 1 diabetes (T1D) are living longer, presenting a unique understudied population with advanced complex needs. This article is a review of the aging literature in T1D and identifies existing gaps while serving as a call to the research community.
Recent studies have identified an association between cognitive impairment and glycemic variability, as well as increased risk and frequency of hypoglycemia in older adults with T1D. However, limited research exists about additional physical and mental health conditions and barrier to successful treatment in this population.
Older adults may experience both age- and diabetes-related barriers to diabetes management. Due to the scarcity of aging T1D research, current treatment guidelines for this age group are based on type 2 diabetes research. There is a critical need to further investigate the physical and mental effects of T1D and aging as well as public health policy; insurance challenges; and needs for support and interventions for older adults with T1D.
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Type 1 diabetes
Continuous glucose monitor
American Diabetes Association
Continuous subcutaneous insulin infusion
Fear of hypoglycemia
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Imperatore G, Boyle JP, Thompson TJ, et al. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050. Diabetes Care. 2012;35(12):2515 LP - 2520. https://doi.org/10.2337/dc12-0669.
Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014;311(17):1778–86. https://doi.org/10.1001/jama.2014.3201.
Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ. Improvements in the life expectancy of type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study cohort. Diabetes. 2012;61(11):2987–92. https://doi.org/10.2337/db11-1625.
Huo L, Harding JL, Peeters A, Shaw JE, Magliano DJ. Life expectancy of type 1 diabetic patients during 1997–2010: a national Australian registry-based cohort study. Diabetologia. 2016;59(6):1177–85. https://doi.org/10.1007/s00125-015-3857-4.
American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S152–62. https://doi.org/10.2337/dc20-S012.
American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S66–76. https://doi.org/10.2337/dc20-S006.
Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342–56. https://doi.org/10.1111/jgs.12035.
Beverly EA, Ritholz MD, Shepherd C, Weinger K. The psychosocial challenges and care of older adults with diabetes: “can’t do what I used to do; can’t be who I once was”. Curr Diab Rep. 2016;16(6):48. https://doi.org/10.1007/s11892-016-0741-7.
Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126–40. https://doi.org/10.2337/dc16-2053.
Dhaliwal R, Weinstock RS. Management of type 1 diabetes in older adults. Diabetes Spectr. 2014;27(1):9–20. https://doi.org/10.2337/diaspect.27.1.9.
Hautala N, Siiskonen M, Hannula V, Järvinen K, Falck A. Early glycaemic control for maintaining visual function in type 1 diabetes: the Oulu cohort study of diabetic retinopathy. Eur J Ophthalmol. 2018;28(6):684–9. https://doi.org/10.1177/1120672117750053.
Fong DS, Aiello L, Gardner TW, et al. Retinopathy in diabetes. Diabetes Care. 2004;27(Suppl. 1):S84–7. https://doi.org/10.2337/diacare.27.2007.S84.
Khan MI, Barlow RB, Weinstock RS. Acute hypoglycemia decreases central retinal function in the human eye. Vis Res. 2011;51(14):1623–6. https://doi.org/10.1016/j.visres.2011.05.003.
Kimbro LB, Mangione CM, Steers WN, Duru OK, McEwen L, Karter A, et al. Depression and all-cause mortality in persons with diabetes mellitus: are older adults at higher risk? Results from the translating research into action for diabetes study. J Am Geriatr Soc. 2014;62(6):1017–22. https://doi.org/10.1111/jgs.12833.
Laiteerapong N, Karter A, Liu J, Moffet HH, Sudore R, Schillinger D, et al. Correlates of quality of life in older adults with diabetes. The Diabetes & Aging Study. Diabetes Care. 2011;34(8):1749–53. https://doi.org/10.2337/dc10-2424.
Sozen T, Calik Basaran N, Tinazli M, Ozisik L. Musculoskeletal problems in diabetes mellitus. Eur J Rheumatol. 2018;5(4):258–65. https://doi.org/10.5152/eurjrheum.2018.18044.
Koh S, Nakamura S, Hattori T, Hirata H. Trigger digits in diabetes: their incidence and characteristics. J Hand Surg Eur Vol. 2010;35(4):302–5. https://doi.org/10.1177/1753193409341103.
Pfützner J, Hellhammer J, Musholt P, Pfützner AH, Böhnke J, Torsten H, et al. Evaluation of dexterity in insulin-treated patients with type 1 and type 2 diabetes mellitus. J Diabetes Sci Technol. 2011;5(1):158–65. https://doi.org/10.1177/193229681100500122.
Shah VN, Wu M, Foster N, Dhaliwal R, Al Mukaddam M. Severe hypoglycemia is associated with high risk for falls in adults with type 1 diabetes. Arch Osteoporos. 2018;13(1):66. https://doi.org/10.1007/s11657-018-0475-z.
Foster NC, Beck RW, Miller KM, Clements MA, Rickels MR, DiMeglio L, et al. State of type 1 diabetes management and outcomes from the T1D Exchange in 2016–2018. Diabetes Technol Ther. 2019;21(2):66–72. https://doi.org/10.1089/dia.2018.0384.
Ryan CM, Klein BEK, Lee KE, Cruickshanks KJ, Klein R. Associations between recent severe hypoglycemia, retinal vessel diameters, and cognition in adults with type 1 diabetes. J Diabetes Complicat. 2016;30(8):1513–8. https://doi.org/10.1016/j.jdiacomp.2016.08.010.
Talley M, Pryor E, Wadley V, Crowe M, Morrison S, Vance D. The physiological mechanisms of diabetes and aging on brain health and cognition. J Neurosci Nurs. 2015;47(5):E12–22. https://doi.org/10.1097/JNN.0000000000000156.
Munshi MN. Cognitive dysfunction in older adults with diabetes: what a clinician needs to know. Diabetes Care. 2017;40(4):461–7. https://doi.org/10.2337/dc16-1229.
Lacy ME, Gilsanz P, Karter AJ, Quesenberry CP, Pletcher MJ, Whitmer RA. Long-term glycemic control and dementia risk in type 1 diabetes. Diabetes Care. 2018;41(11):2339–45. https://doi.org/10.2337/dc18-0073.
•• Gilsanz P, Schnaider Beeri M, Karter AJ, Quesenberry CP, Adams AS, Whitmer RA. Depression in type 1 diabetes and risk of dementia. Aging Ment Health. 2019;23(7):880–6. https://doi.org/10.1080/13607863.2018.1455167This study provides evidence that risk of dementia is significantly increased with the occurrence of depression in adults with type 1 diabetes aged ≥ 50.
Markowitz SM, Gonzalez JS, Wilkinson JL, Safren SA. A review of treating depression in diabetes: emerging findings. Psychosomatics. 2011;52(1):1–18. https://doi.org/10.1016/j.psym.2010.11.007.
Trief PM, Xing D, Foster NC, Maahs DM, Kittelsrud JM, Olson BA, et al. Depression in adults in the T1D Exchange clinic registry. Diabetes Care. 2014;37(6):1563–72. https://doi.org/10.2337/dc13-1867.
de Groot M, Golden SH, Wagner J. Psychological conditions in adults with diabetes. Am Psychol. 2016;71(7):552–62. https://doi.org/10.1037/a0040408.
Reddy J, Wilhelm K, Campbell L. Putting PAID to diabetes-related distress: the potential utility of the problem areas in diabetes (PAID) scale in patients with diabetes. Psychosomatics. 2013;54(1):44–51. https://doi.org/10.1016/j.psym.2012.08.004.
Sturt J, Dennick K, Due-Christensen M, McCarthy K. The detection and management of diabetes distress in people with type 1 diabetes. Curr Diab Rep. 2015;15(11):101. https://doi.org/10.1007/s11892-015-0660-z.
Hessler DM, Fisher L, Polonsky WH, Masharani U, Strycker LA, Peters AL, et al. Diabetes distress is linked with worsening diabetes management over time in adults with type 1 diabetes. Diabet Med. 2017;34(9):1228–34. https://doi.org/10.1111/dme.13381.
Smith KJ, Béland M, Clyde M, Gariépy G, Pagé V, Badawi G, et al. Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res. 2013;74(2):89–99. https://doi.org/10.1016/j.jpsychores.2012.11.013.
Martyn-Nemeth P, Schwarz Farabi S, Mihailescu D, Nemeth J, Quinn L. Fear of hypoglycemia in adults with type 1 diabetes: impact of therapeutic advances and strategies for prevention - a review. J Diabetes Complicat. 2016;30(1):167–77. https://doi.org/10.1016/j.jdiacomp.2015.09.003.
Böhme P, Bertin E, Cosson E, Chevalier N, GEODE group. Fear of hypoglycaemia in patients with type 1 diabetes: do patients and diabetologists feel the same way? Diabetes Metab. 2013;39(1):63–70. https://doi.org/10.1016/j.diabet.2012.10.006.
Anderbro T, Amsberg S, Wredling R, Lins PE, Adamson U, Lisspers J, et al. Psychometric evaluation of the Swedish version of the Hypoglycaemia Fear Survey. Patient Educ Couns. 2008;73(1):127–31. https://doi.org/10.1016/j.pec.2008.03.022.
Argento NB, Liu J, Hughes AS, McAuliffe-Fogarty AH. Impact of Medicare continuous subcutaneous insulin infusion policies in patients with type 1 diabetes. J Diabetes Sci Technol. 2019;193229681983829. https://doi.org/10.1177/1932296819838292.
Caspersen CJ, Thomas GD, Boseman LA, Beckles GLA, Albright AL. Aging, diabetes, and the public health system in the United States. Am J Public Health. 2012;102(8):1482–97. https://doi.org/10.2105/AJPH.2011.300616.
Peron EP, Ogbonna KC, Donohoe KL. Antidiabetic medications and polypharmacy. Clin Geriatr Med. 2015;31(1):17–27. https://doi.org/10.1016/j.cger.2014.08.017.
Bauer S, Nauck MA. Polypharmacy in people with type 1 and type 2 diabetes is justified by current guidelines-a comprehensive assessment of drug prescriptions in patients needing inpatient treatment for diabetes-associated problems. Diabet Med. 2014;31(9):1078–85. https://doi.org/10.1111/dme.12497.
Dhalwani NN, Fahami R, Sathanapally H, Seidu S, Davies MJ, Khunti K. Association between polypharmacy and falls in older adults: a longitudinal study from England. BMJ Open. 2017;7(10):e016358. https://doi.org/10.1136/bmjopen-2017-016358.
Grant RW, Devita NG, Singer DE, Meigs JB. Polypharmacy and medication adherence in patients with type 2 diabetes. Diabetes Care. 2003;26(5):1408–12. https://doi.org/10.2337/diacare.26.5.1408.
Roussel R, Moutairou A, Riveline J-P, Gautier J-F, Potier L. 1091-P: association between mild and severe hypoglycemia in people with T1 and T2 diabetes enrolled in randomized controlled trials for assessing insulin therapy. Diabetes. 2019;68(Suppl. 1):1091. https://doi.org/10.2337/db19-1091-P.
Yeoh E, Choudhary P, Nwokolo M, Ayis S, Amiel SA. Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis. Diabetes Care. 2015;38(8):1592–609. https://doi.org/10.2337/dc15-0102.
Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R, et al. Frequency and predictors of hypoglycaemia in type 1 and insulin-treated type 2 diabetes: a population-based study. Diabet Med. 2005;22(6):749–55. https://doi.org/10.1111/j.1464-5491.2005.01501.x.
Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, et al. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry. J Clin Endocrinol Metab. 2013;98(8):3411–9. https://doi.org/10.1210/jc.2013-1589.
Weinstock RS, DuBose SN, Bergenstal RM, Chaytor NS, Peterson C, Olson BA, et al. Risk factors associated with severe hypoglycemia in older adults with type 1 diabetes. Diabetes Care. 2016;39(4):603–10. https://doi.org/10.2337/dc15-1426.
DuBose SN, Weinstock RS, Beck RW, Peters AL, Aleppo G, Bergenstal RM, et al. Hypoglycemia in older adults with type 1 diabetes. Diabetes Technol Ther. 2016;18(12):765–71. https://doi.org/10.1089/dia.2016.0268.
•• Chaytor NS, Barbosa-Leiker C, Ryan CM, Germine LT, Hirsch IB, Weinstock RS. Clinically significant cognitive impairment in older adults with type 1 diabetes. J Diabetes Complicat. 2019;33(1):91–7. https://doi.org/10.1016/j.jdiacomp.2018.04.003This study identified the prevalence of clinically significant cognitive impairment in older adults with type 1 diabetes and diabetes-related factors correlated with impairment.
Mattishent K, Richardson K, Dhatariya K, Savva GM, Fox C, Loke YK. The effects of hypoglycaemia and dementia on cardiovascular events, falls and fractures and all-cause mortality in older individuals: a retrospective cohort study. Diabetes Obes Metab. 2019:1–10. https://doi.org/10.1111/dom.13769.
Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012;142(Suppl):S8–21. https://doi.org/10.1016/S0165-0327(12)70004-6.
Bădescu SV, Tătaru C, Kobylinska L, Georgescu EL, Zahiu DM, Zăgrean AM, et al. The association between diabetes mellitus and depression. J Med Life. 2016;9(2):120–5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863499/.
Administration SA and MHS. Key substance use and mental health indicators in the United States: results from the 2017 National Survey on Drug Use and Health. Rockville, MD; 2018. https://www.samhsa.gov/data/. Accessed 10 Feb 2020.
Hagger V, Hendrieckx C, Sturt J, Skinner TC, Speight J. Diabetes distress among adolescents with type 1 diabetes: a systematic review. Curr Diab Rep. 2016;16(1):9. https://doi.org/10.1007/s11892-015-0694-2.
Munshi MN, Florez H, Huang ES, Kalyani RR, Mupanomunda M, Pandya N, et al. Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(2):308–18. https://doi.org/10.2337/dc15-2512.
Polonsky WH, Peters AL, Hessler D. The impact of real-time continuous glucose monitoring in patients 65 years and older. J Diabetes Sci Technol. 2016;10(4):892–7. https://doi.org/10.1177/1932296816643542.
Conflict of Interest
Jeoffrey A. Bispham, Allyson S. Hughes, and Alicia H. McAuliffe-Fogarty each declare no potential conflicts of interest.
Kimberly A. Driscoll reports personal fees from T1D Exchange, during the conduct of the study, and personal fees from T1D Exchange, outside the submitted work.
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Bispham, J.A., Hughes, A.S., Driscoll, K.A. et al. Novel Challenges in Aging with Type 1 Diabetes. Curr Diab Rep 20, 15 (2020). https://doi.org/10.1007/s11892-020-01298-9
- Older adults
- Type 1 diabetes
- Mental health