Skip to main content

Advertisement

SpringerLink
Log in

Dietary Management of Glycemic Control in Older Adults

  • Nutrition and Aging (MC Serra, Section Editor)
  • Published:
Current Nutrition Reports Aims and scope Submit manuscript

Abstract

Older adults are increasingly at risk for prediabetes and type 2 diabetes, which may lead to further morbidity and mortality. Nutrition and other lifestyle interventions can effectively reduce the likelihood of developing hyperglycemia. Research in older adults is ongoing to determine the best way to help this population maintain or improve glycemic control. This review highlights recent nutrition-related literature evaluating associations between the development of type 2 diabetes and vitamin D, minerals, antioxidants, omega-3 fatty acids, eggs, and meats. Further, the review addresses the efficacy of intensive and once-annual lifestyle interventions for blood glucose management in nondiabetic older adults. Recently published work generally reinforces prior research and altogether indicates that older adults with prediabetes should strive to consume low-cholesterol protein choices and high-antioxidant foods (e.g., fruits, vegetables, tea, and coffee). Further, older adults with prediabetes and a BMI ≥ 25 should consume a lower-energy diet sufficient to promote a 7 % weight loss and complete at least 150 min of moderate-intensity physical activity each week.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Caspersen CJ, Thomas GD, Beckles GL, Bullard KM. Secular changes in prediabetes indicators among older-adult Americans, 1999-2010. Am J Prev Med. 2015;48:253–63.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ligthart S, van Herpt TT, Leening MJ, Kavousi M, Hofman A, Stricker BH, et al. Lifetime risk of developing impaired glucose metabolism and eventual progression from prediabetes to type 2 diabetes: a prospective cohort study. Lancet Diabetes Endocrinol. 2016;4:44–51.

    Article  PubMed  Google Scholar 

  3. Ahmann A. Reduction of hospital costs and length of stay by good control of blood glucose levels. Endocr Pract. 2004;2(10 Suppl):53–6.

    Article  Google Scholar 

  4. Baker EH, Janaway CH, Philips BJ, Brennan AL, Baines DL, Wood DM, et al. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax. 2006;61:284–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78:1471–8.

    Article  PubMed  Google Scholar 

  6. Olveira G, Tapia MJ, Ocón J, Cabrejas-Gómez C, Ballesteros-Pomar MD, Vidal-Casariego A, et al. Parenteral nutrition-associated hyperglycemia in non-critically ill inpatients increases the risk of in-hospital mortality (multicenter study). Diabetes Care. 2013;35:1061–6.

    Article  Google Scholar 

  7. Sarkisian S, Fenton TR, Shaheen AA, Raman M. Parenteral nutrition-associated hyperglycemia in noncritically ill inpatients is associated with higher mortality. Can J Gastroenterol. 2010;24:453–7.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Stead LG, Gilmore RM, Bellolio MF, Mishra S, Bhagra A, Vaidyanathan L, et al. Hyperglycemia as an independent predictor of worse outcome in non-diabetic patients presenting with acute ischemic stroke. Neurocrit Care. 2009;10:181–6.

    Article  PubMed  Google Scholar 

  9. Baker ST, Chiang CY, Zajac JD, Bach LA, Jerums G, MacIsaac RJ. Outcomes for general medical inpatients with diabetes mellitus and new hyperglycaemia. Med J Aust. 2008;188:340–3.

    PubMed  Google Scholar 

  10. Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med. 2015;175:356–62.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Association AD. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2007;30 Suppl 1:S48–65.

    Article  Google Scholar 

  12. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults. Diabetes Care. 2012;35:2650–64.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bardenheier BH, Bullard KM, Caspersen CJ, Cheng YJ, Gregg EW, Geiss LS. A novel use of structural equation models to examine factors associated with prediabetes among adults aged 50 years and older: National Health and Nutrition Examination Survey 2001-2006. Diabetes Care. 2013;36:2655–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Campbell AP, Rains TM. Dietary protein is important in the practical management of prediabetes and type 2 diabetes. J Nutr. 2015;145:164S–9S.

    Article  CAS  PubMed  Google Scholar 

  15. Scragg R, Holdaway I, Singh V, Metcalf P, Baker J, Dryson E. Serum 25-hydroxyvitamin D3 levels decreased in impaired glucose tolerance and diabetes mellitus. Diabetes Res Clin Pract. 1995;27:181–8.

    Article  CAS  PubMed  Google Scholar 

  16. Okubo H, Syddall HE, Phillips DI, Sayer AA, Dennison EM, Cooper C, et al. Dietary total antioxidant capacity is related to glucose tolerance in older people: the Hertfordshire Cohort Study. Nutr Metab Cardiovasc Dis. 2014;24:301–8. This study demonstrated that high dietary intake of antioxidants is associated with better insulin sensitivity and better glucose tolerance, with a statistically stronger association for obese older women. Overall, coffee, tea, fruits, and vegetable contributed the most TAC to the diets of study participants.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Levine RA, Streeten DH, Doisy RJ. Effects of oral chromium supplementation on the glucose tolerance of elderly human subjects. Metabolism. 1968;17:114–25.

    Article  CAS  PubMed  Google Scholar 

  18. Wang ZQ, Yu Y, Zhang XH, Komorowski J. Chromium-insulin reduces insulin clearance and enhances insulin signaling by suppressing hepatic insulin-degrading enzyme and proteasome protein expression in KKAy mice. Front Endocrinol (Lausanne). 2014;5:99.

    Google Scholar 

  19. Chung JH, Yum KS. Correlation of hair mineral concentrations with insulin resistance in Korean males. Biol Trace Elem Res. 2012;150(1–3):26–30.

    Article  PubMed  Google Scholar 

  20. Bahijri SM. Effect of chromium supplementation on glucose tolerance and lipid profile. Saudi Med J. 2000;21:45–50.

    CAS  PubMed  Google Scholar 

  21. Bahijri SM, Alissa EM. Increased insulin resistance is associated with increased urinary excretion of chromium in non-diabetic, normotensive Saudi adults. J Clin Biochem Nutr. 2011;49:164–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Basaki M, Saeb M, Nazifi S, Shamsaei HA. Zinc, copper, iron, and chromium concentrations in young patients with type 2 diabetes mellitus. Biol Trace Elem Res. 2012;148:161–4.

    Article  CAS  PubMed  Google Scholar 

  23. Landman GW, Bilo HJ, Houweling ST, Kleefstra N. Chromium does not belong in the diabetes treatment arsenal: current evidence and future perspectives. World J Diabetes. 2014;5:160–4.

    PubMed  PubMed Central  Google Scholar 

  24. Davis CM, Vincent JB. Chromium oligopeptide activates insulin receptor tyrosine kinase activity. Biochemistry. 1997;36:4382–5.

    Article  CAS  PubMed  Google Scholar 

  25. Dong F, Kandadi MR, Ren J, Sreejayan N. Chromium (D-phenylalanine)3 supplementation alters glucose disposal, insulin signaling, and glucose transporter-4 membrane translocation in insulin-resistant mice. J Nutr. 2008;138:1846–51.

    CAS  PubMed  Google Scholar 

  26. Rafiei R, Habyby Z, Fouladi L, Najafi S, Asgary S, Torabi Z. Chromium level in prediction of diabetes in pre-diabetic patients. Adv Biomed Res. 2014;3:235.

    Article  PubMed  PubMed Central  Google Scholar 

  27. McIver DJ, Grizales AM, Brownstein JS, Goldfine AB. Risk of type 2 diabetes is lower in US adults taking chromium-containing supplements. J Nutr. 2015;145:2675–82.

    Article  PubMed  Google Scholar 

  28. Bailey CH. Improved meta-analytic methods show no effect of chromium supplements on fasting glucose. Biol Trace Elem Res. 2014;157(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  29. Wood RJ, Suter PM, Russell RM. Mineral requirements of elderly people. Am J Clin Nutr. 1995;62:493–505.

    CAS  PubMed  Google Scholar 

  30. Rosolova H, Mayer O, Reaven G. Effect of variations in plasma magnesium concentration on resistance to insulin-mediated glucose disposal in nondiabetic subjects. J Clin Endocrinol Metab. 1997;82:3783–5.

    CAS  PubMed  Google Scholar 

  31. Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. Failure of beta-cell function to compensate lack of insulin action in hyperuricemic subjects. Diabetes Metab Res Rev. 2009;25:535–41.

    Article  PubMed  Google Scholar 

  32. Rodríguez-Morán M, Guerrero-Romero F. Insulin secretion is decreased in non-diabetic individuals with hypomagnesaemia. Diabetes Metab Res Rev. 2011;27:590–6.

    Article  PubMed  Google Scholar 

  33. Fang C, Wang X, Wu W, Gu X, Ye T, Deng H, et al. Association of serum magnesium level with odds of prediabetes and diabetes in a southern Chinese population: a prospective nested case-control study. Biol Trace Elem Res. 2015.

  34. Mooren FC. Magnesium and disturbances in carbohydrate metabolism. Diabetes Obes Metab. 2015;17:813–23. A paper is a review identifying eight studies of magnesium supplementation in prediabetic, middle-aged participants. Five of the eight studies showed decreases in fasting plasma glucose after supplementation with approximately 270 mg of magnesium each day for 12–24 weeks, with more pronounced decreases in those studies where the only participants are those with hypomagnesemia.

    Article  CAS  PubMed  Google Scholar 

  35. Sebastian RS, Cleveland LE, Goldman JD, Moshfegh AJ. Older adults who use vitamin/mineral supplements differ from nonusers in nutrient intake adequacy and dietary attitudes. J Am Diet Assoc. 2007;107:1322–32.

    Article  CAS  PubMed  Google Scholar 

  36. Gloth FM, Tobin JD. Vitamin D deficiency in older people. J Am Geriatr Soc. 1995;43:822–8.

    Article  PubMed  Google Scholar 

  37. Baynes KC, Boucher BJ, Feskens EJ, Kromhout D. Vitamin D, glucose tolerance and insulinaemia in elderly men. Diabetologia. 1997;40:344–7.

    Article  CAS  PubMed  Google Scholar 

  38. Mauss D, Jarczok MN, Hoffmann K, Thomas GN, Fischer JE. Association of vitamin D levels with type 2 diabetes in older working adults. Int J Med Sci. 2015;12:362–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Maestro B, Molero S, Bajo S, Dávila N, Calle C. Transcriptional activation of the human insulin receptor gene by 1,25-dihydroxyvitamin D(3). Cell Biochem Funct. 2002;20:227–32.

    Article  CAS  PubMed  Google Scholar 

  40. Maestro B, Campión J, Dávila N, Calle C. Stimulation by 1,25-dihydroxyvitamin D3 of insulin receptor expression and insulin responsiveness for glucose transport in U-937 human promonocytic cells. Endocr J. 2000;47:383–91.

    Article  CAS  PubMed  Google Scholar 

  41. Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol. 2010;2010:351385.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Guan C, Zhen D, Tang X, Yang X, Zhu T, Fu S, et al. The status of 25-hydroxyvitamin D across the spectrum of glucose tolerance among middle-aged and elderly Chinese individuals. Clin Endocrinol (Oxf). 2014;81:834–40.

    Article  CAS  Google Scholar 

  43. Tuomainen TP, Virtanen JK, Voutilainen S, Nurmi T, Mursu J, de Mello VD, et al. Glucose metabolism effects of vitamin D in prediabetes: the VitDmet randomized placebo-controlled supplementation study. J Diabetes Res. 2015;2015:672653. This study demonstrated that improving vitamin D status in Finnish older adults with supplementation of vitamin D3 did not improve glycemic status; therefore, vitamin D supplementation alone may not be an efficacious approach to manage aberrant glycemic responses in older adults.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Seida JC, Mitri J, Colmers IN, Majumdar SR, Davidson MB, Edwards AL, et al. Clinical review: effect of vitamin D3 supplementation on improving glucose homeostasis and preventing diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99:3551–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Lind L, Pollare T, Hvarfner A, Lithell H, Sørensen OH, Ljunghall S. Long-term treatment with active vitamin D (alphacalcidol) in middle-aged men with impaired glucose tolerance. Effects on insulin secretion and sensitivity, glucose tolerance and blood pressure. Diabetes Res. 1989;11:141–7.

    CAS  PubMed  Google Scholar 

  46. Fliser D, Stefanski A, Franek E, Fode P, Gudarzi A, Ritz E. No effect of calcitriol on insulin-mediated glucose uptake in healthy subjects. Eur J Clin Invest. 1997;27:629–33.

    Article  CAS  PubMed  Google Scholar 

  47. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92:2017–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Donath MY, Shoelson SE. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol. 2011;11:98–107.

    Article  CAS  PubMed  Google Scholar 

  49. Nettleton JA, Katz R. n-3 long-chain polyunsaturated fatty acids in type 2 diabetes: a review. J Am Diet Assoc. 2005;105:428–40.

    Article  CAS  PubMed  Google Scholar 

  50. Djoussé L, Biggs ML, Lemaitre RN, King IB, Song X, Ix JH, et al. Plasma omega-3 fatty acids and incident diabetes in older adults. Am J Clin Nutr. 2011;94:527–33. This large meta-analysis in aging and older adults successfully determined a threshold for safe egg consumption. The authors concluded that consuming up to 3 eggs each week is probably safe for aging and older adults in all parts of the world.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Wall R, Ross RP, Fitzgerald GF, Stanton C. Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids. Nutr Rev. 2010;68:280–9.

    Article  PubMed  Google Scholar 

  52. Papanikolaou Y, Brooks J, Reider C, Fulgoni VL. U.S. adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003-2008. Nutr J. 2014;13:31.

  53. Virtanen JK, Mursu J, Voutilainen S, Uusitupa M, Tuomainen TP. Serum omega-3 polyunsaturated fatty acids and risk of incident type 2 diabetes in men: the Kuopio Ischemic Heart Disease Risk Factor study. Diabetes Care. 2014;37:189–96.

    Article  CAS  PubMed  Google Scholar 

  54. Abbott KA, Veysey M, Lucock M, Niblett S, King K, Burrows T, et al. Sex-dependent association between erythrocyte n-3 PUFA and type 2 diabetes in older overweight people. Br J Nutr. 2016; Feb:1–8.

  55. Hutchins AM, Brown BD, Cunnane SC, Domitrovich SG, Adams ER, Bobowiec CE. Daily flaxseed consumption improves glycemic control in obese men and women with pre-diabetes: a randomized study. Nutr Res. 2013;33:367–75.

    Article  CAS  PubMed  Google Scholar 

  56. Razny U, Kiec-Wilk B, Polus A, Goralska J, Malczewska-Malec M, Wnek D, et al. Effect of caloric restriction with or without n-3 polyunsaturated fatty acids on insulin sensitivity in obese subjects: a randomized placebo controlled trial. BBA Clin. 2015;4:7–13.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Djoussé L, Kamineni A, Nelson TL, Carnethon M, Mozaffarian D, Siscovick D, et al. Egg consumption and risk of type 2 diabetes in older adults. Am J Clin Nutr. 2010;92:422–7.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Tajima R, Kodama S, Hirata M, Horikawa C, Fujihara K, Yachi Y, et al. High cholesterol intake is associated with elevated risk of type 2 diabetes mellitus—a meta-analysis. Clin Nutr. 2014;33:946–50.

    Article  CAS  PubMed  Google Scholar 

  59. Djoussé L, Khawaja OA, Gaziano JM. Egg consumption and risk of type 2 diabetes: a meta-analysis of prospective studies. Am J Clin Nutr. 2016;103:474–80.

    Article  PubMed  Google Scholar 

  60. Fretts AM, Follis JL, Nettleton JA, Lemaitre RN, Ngwa JS, Wojczynski MK, et al. Consumption of meat is associated with higher fasting glucose and insulin concentrations regardless of glucose and insulin genetic risk scores: a meta-analysis of 50,345 Caucasians. Am J Clin Nutr. 2015;102:1266–78. This meta-analysis in aging and older adults showed a small association between processed and unprocessed meat intake and poorer glycemic outcomes. Readers should note that the effect was small enough that it may not be clinically relevant and the relationships were largely attenuated when BMI was included in the statistical model.

    Article  PubMed  Google Scholar 

  61. Mekary RA, Giovannucci E, Cahill L, Willett WC, van Dam RM, Hu FB. Eating patterns and type 2 diabetes risk in older women: breakfast consumption and eating frequency. Am J Clin Nutr. 2013;98:436–43. This study of older women demonstrated that consistent daily breakfast consumption is associated with less risk for developing type 2 diabetes. Furthermore, consuming meals and snacks only 1–3 times each day was significantly associated with lower BMI. The authors concluded that it is may be best for older women to consume breakfast and eating only 1–3 times a day to minimize the risk of developing type 2 diabetes.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Okumiya K, Sakamoto R, Fujisawa M, Wada T, Chen WL, Imai H, et al. Effect of early diagnosis and lifestyle modification on functional activities in community-dwelling elderly adults with glucose intolerance: 5-year longitudinal study. J Am Geriatr Soc. 2015;63:190–2. This intervention in community-dwelling older Japanese adults showed that an annual health assessment and education was sufficient to reduce functional decline in nondiabetic and prediabetic older adults who participated most of the time. This research showed that group lifestyle education just once a year can promote better functional outcomes in some groups of older adults with prediabetes.

    Article  PubMed  Google Scholar 

  63. Ory MG, Jordan PJ, Bazzarre T. The Behavior Change Consortium: setting the stage for a new century of health behavior-change research. Health Educ Res. 2002;17:500–11.

    Article  CAS  PubMed  Google Scholar 

  64. Lee LL, Arthur A, Avis M. Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper. Int J Nurs Stud. 2008;45:1690–9.

    Article  PubMed  Google Scholar 

  65. Brokaw SM, Carpenedo D, Campbell P, Butcher MK, Furshong G, Helgerson SD, et al. Effectiveness of an adapted diabetes prevention program lifestyle intervention in older and younger adults. J Am Geriatr Soc. 2015;63:1067–74. This study compared the efficacy of group education-based DPP in older and middle-aged adults in Montana. The older adults were more likely to self-monitor and completed significantly more physical activity when compared with younger participants. The program effectively allowed older adults with prediabetes to lose weight and improve glycemic indicators. This study showed that the DPP administered in a group may be efficacious for older adults in the USA.

    Article  PubMed  Google Scholar 

  66. McLaughlin AC, Whitlock LA, Lester KL, McGraw AE. Older adults’ self-reported barriers to adherence to dietary guidelines and strategies to overcome them. J Health Psychol. 2015

Download references

Author information

Authors and Affiliations

  1. University of Texas Medical Branch, Galveston, TX, 77555-1124, USA

    Jean L. Gutierrez & Emily J. Arentson-Lantz

Authors
  1. Jean L. Gutierrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily J. Arentson-Lantz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean L. Gutierrez.

Ethics declarations

Conflict of Interest

Jean L. Gutierrez and Emily J. Arentson-Lantz declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Nutrition and Aging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gutierrez, J.L., Arentson-Lantz, E.J. Dietary Management of Glycemic Control in Older Adults. Curr Nutr Rep 5, 119–127 (2016). https://doi.org/10.1007/s13668-016-0159-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13668-016-0159-5

Keywords

Search

Navigation