Skip to main content

Diabetes Mellitus in the Elderly

  • Reference work entry
  • First Online:
Geriatric Diseases

Abstract

Worldwide the incidence and prevalence of diabetes mellitus (DM) increase with age. With the adoption of the new diagnostic criteria and people living longer, the prevalence of DM is likely to increase. A new problem that is disturbing is the rise of type 2 diabetes mellitus (T2DM) in young people. This chapter provides an update on the mechanisms of action, use, contraindications and adverse effects of the medications used in the clinical management in DM. The elderly often do not present with usual classic symptoms of polyuria, polydipsia and polyphagia. They may present only with one or more of the geriatric syndromes, namely, falls, incontinence, decreased cognition or fatigue, lethargy or weight loss. The management of diabetes in the elderly is complex, but in general the principles of management are similar to that of younger patients.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 379.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gesing A, Lewinski A, Karbownck-Lewinski M. The thyroid gland and the process of aging: what is new? Thyroid Res. 2012; 5:16. https://doi.org/10.1186/1756-6614-5-16.

  2. Noth RH, Mazzaferri EI. Ageing and the endocrine system. Clin Geriatr Med. 1985;1(1):223–50.

    CAS  PubMed  Google Scholar 

  3. Elahi D, Muller DC. Carbohydrate metabolism in the elderly. Eur J Clin Nutrition. 2000;54:S112–120.

    Article  CAS  Google Scholar 

  4. Zimmer P, Alberti KG, Shaw J. Global and societal implications of diabetes epidemic. Nature. Nature. 2001;414:782–787.

    Article  Google Scholar 

  5. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: Prevalence, numerical estimates and projections. Diabetes Care. 1998;21:1414–1431.

    Article  CAS  PubMed  Google Scholar 

  6. Gregg EW, Mangione CM, Cauley JA, Thompson TJ, Schwartz AV, Ensrud KE, et al. Diabetes and incidence of functional disability in older women. Diabetes Care. 2002; 23:1272–1277.

    Article  Google Scholar 

  7. Khinvasara RK. Diabetes in the elderly. Diabetes Today. 2004;(3):5.

    Google Scholar 

  8. Rockwood K, Await E, Macknight C, McDowell I. Incidence and outcomes of diabetes mellitus in elderly people. Report from the Canadian Study of Health and Aging. CMAJ 2000;162(6):769–772.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Bloomgarden ZT. Type 2 diabetes I the young. American Diabetes Association. Diabetes Care. 2004;27(4):998–1010.

    Article  PubMed  Google Scholar 

  10. Reinehr T. Type 2 diabetes mellitus in children and adolescents. World J Diabetes. 2013; 4(6):270–281.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Song SH. Complication characteristics between young onset type 2 versus type 1 diabetes in a UK population. B MJ Open Diab Res Care. 2015: https://doi.org/10.1136/bmjdrc-20140-000044.

  12. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2004;27:S5–S10.

    Article  Google Scholar 

  13. Halter JB. Diabetes mellitus in older adults: underdiagnosis and undertreatment. J Am Geriatr Soc. 2000; 48:340–341.

    Article  CAS  PubMed  Google Scholar 

  14. Paolisso G. Pathophysiology of diabetes in elderly people. Acta Biomed. 2010; 81 Supp1:47–53.

    PubMed  Google Scholar 

  15. Abbatecola AM, Paolisso G, Corsonello A, Bustacchini S, Lattanzio F. Antidiabetic oral treatment in older people: does frailty matter? Drugs Aging. 2009. 26: Suppl 1:53–62.

    Article  CAS  PubMed  Google Scholar 

  16. Del Prato S, Heine RJ, Keilson L, Guitard C, Shen SG, Emmons RP. Treatment of patients over 64 years of age with type 2 diabetes: experience from nateglinide pooled database retrospective analysis. Diabetes Care. 2003;26: 2075–2080.

    Article  PubMed  Google Scholar 

  17. Gregg EW, Narayan KMV. Type 2 diabetes and cognitive function: are cognitive impairment and dementia complications of diabetes type 2 diabetes? Clin Geriatr. 2000;8:57–72.

    Google Scholar 

  18. Fontibonne A, Berr C, Ducimetiere P, Alper-vitch I. Changes in cognition abilities over a 4-year period are infamously affected in elderly diabetic subjects: results of the epidemiology of vascular aging study. Diabetes Care. 2001;24: 366–370.

    Article  Google Scholar 

  19. Gregg EW, Narayan KMV. Complications of diabetes in elderly people. BMJ. 2002; 325(7370):916–917.

    Google Scholar 

  20. Kirkman SM, Briscoe VJ, Clark N, Florez H, Haas LB, Haters B, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012; 60:2342.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Colman PG, Thomas DW, Zimmet PZ,Welborn TA, Garcia-Webb P, Moore MP. New classification and criteria for diagnosis of diabetes mellitus. MJA. 1999;170:375–378.

    CAS  PubMed  Google Scholar 

  22. Diabetes Mellitus. http://www.patient.co.uk/showdoc/40000914/ retrieved on 623 June 2008.

  23. Balkau B. Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe: the DECODE study: Diabetes Metab. 2000;26:282–286.

    CAS  PubMed  Google Scholar 

  24. The DECODE study Group: Is fasting glucose sufficient to define diabetes? Epidemiological data from 20 European studies. Diabetologia. 1999;42:647–654.

    Article  Google Scholar 

  25. Chau D, Edelman SV. Clinical management of diabetes in the elderly. Clin Diabetes. 2001;19(4):172–175.

    Article  Google Scholar 

  26. Defranzo RB. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58:773–795.

    Article  Google Scholar 

  27. Fink RI, Wallace P, Olefsky JM. Effects of aging in glucose-mediated, glucose disposal and glucose transport. Clin Invest. 1986;77: 2034–41.

    Article  CAS  Google Scholar 

  28. Abbatecola AM, Maggi S, Paolisso G. New approaches to treating type 2 diabetes mellitus in the elderly: role of incretin therapies. Drugs Aging. 2008;25911:913–25.

    Article  Google Scholar 

  29. Paolisso G. Pathophysiology of diabetes in elderly people. Acta Biomed. 2010;81:Suppl 1 :47–53.

    Google Scholar 

  30. McCulloch DK, Munshi M Treatment of type 2 diabetes mellitus in the elderly patient. http://www.uptodate.com/contents/treatment-of-type-2-diabetes-mellitus-in-the

  31. Krentz AJ, Bailey CJ. Oral antidiabetic agents: current role in type 2 diabetes mellitus. Drugs. 2005;65(3):38541.

    Article  Google Scholar 

  32. Abrass IB, Schwartz RS. Special presentation of endocrine disease in the elderly in Clinical Practice of Medicine. Vol 1 No.2. Fitsgerald FT Ed Philadelphia Pa., Current Medicine Inc. 1998 p 415–18.

    Google Scholar 

  33. Katzel LI, Blecker Er, Colman EG, Rogus EM, Sorki JD, Goldberg AP. Effects of weight loss vs aerobic exercise training on risk factors for coronary disease in the elderly, obese, middle-aged men and women. JAMA. 2005; 278: 1915–21.

    Google Scholar 

  34. Wallace JI. Management of diabetes in the elderly. Clin Diabetes 1999;vol. 17 1. http://journal.diabetes.org/c.inocaldiabetes/vi7a11998/Pgpghtm.

    Google Scholar 

  35. Pratley RE, Rosenstock J, Pi-Sunyer FX, Banerji MA, Schweizer A, Couturier A, et al Management of type 2 diabetes in treatment –Naïve elderly patients. Diabetes Care. 2007;30:3017–3022.

    Article  CAS  PubMed  Google Scholar 

  36. Pratley R, Weyer C. The role of impaired insulin secreted in the pathogenesis of type II diabetes mellitus. Diabetologia. 2001;44:929–945.

    Article  CAS  PubMed  Google Scholar 

  37. Abbatecola AM, Paolisso G, Corsonello, A, Bustacchini S, Lattanzio F. Antidiabetic oral treatment in older people: does frailty matter? Drugs Aging 2009;26 Suppl 1:53–62.

    Article  CAS  PubMed  Google Scholar 

  38. Jabbour SA, Goldstein BI Improving disease management with new treatments for type 2 diabetes mellitus. Clin Geriatr. 2001; 9:57–68.

    Google Scholar 

  39. Fuhlendorff J, Rorsman P, Kosfod H, Brand CL, Rolia B, Mackay P, al. Stimulation of insulin release by repaglinide and glibenclamide involves both common and distinct processes . Diabetes. 1998;47(23):345–351.

    Article  CAS  PubMed  Google Scholar 

  40. Bosenberg LH, van Zyl DG. The mechanism of action of oral antidiabetic drugs, A review of recent literature. Review. JEMDSA. 2008; 13(3):80–88.

    Google Scholar 

  41. Kirpichnikov D, McFarlane SI, Sowers JR. Metformin: an update. Ann Intern Med 2002;137(1):25–33.

    Article  CAS  PubMed  Google Scholar 

  42. Cusi K, de Fronzo RA. Metformin, a review of its metabolic effects. Diabetes Rev. 1998; 6:89–131.

    Google Scholar 

  43. Lee A, Morley JE. Metformin anorexia and weight loss. Obesity Res 1998; 6:47–53.

    Article  CAS  Google Scholar 

  44. Stumvoil M, Haring HU. Glitazones: clinical effects and molecular mechanisms. Ann Med. 2002; 34(3):217–24.

    Article  Google Scholar 

  45. Beebe KI, Patel J. Rosiglitazone is effective and well tolerated in patients over 65 years with type 2 diabetes. Diabetes 1999; 48 (suppl 1):111.

    Google Scholar 

  46. Bischoff H. Pharmacology of alpha-glucosidase inhibition. Eur J Clin Invest. 1994; 24 Suppl 3: 370.

    Google Scholar 

  47. Mari A, Sallas WM , He YL, Watson, Liqueros-Saylan M, Dunnong BE, et al. Vildagliptin, a dipeptidyl peptidase-IV inhibitor, improves model-assessed b-cell function in patients with type 2 diabetes. J Clin Endocrinol Metab. 2005; 90: 4888–4894.

    Article  CAS  PubMed  Google Scholar 

  48. Palalau AI, Tahrani AA, Piya MK, Barnett AH. DPP-4 inhibitors in clinical practice. Postgrad Med. 2009; 121(6):70–100.

    Article  PubMed  Google Scholar 

  49. Schwartz SL. Treatment of elderly patients with type 2 diabetes: a systematic review of the benefits and risks of dipeptidyl peptidase-4 inhibitor. Am J Ger Pharmacother. 2010; 8(5):405–18.

    Article  CAS  Google Scholar 

  50. Thornberry NA , Gallwitz B. Mechanism of action of inhibitors of dipeptidyl-peptidase-4 (DPP-4). Best Pract Res Clin Endocrinol Metab. 2009;23(4):479–86.

    Article  CAS  PubMed  Google Scholar 

  51. Nauck MA, Heimesaat MM, Behle K, Holst JJ, Nauck MS, Ritzel R, et al. Effects of glucagon-like peptide 1 on counter regulatory hormone responses cognitive functions and insulin secretion during hyperinsulinemic, stepped hypoglycaemic clamp experiments in healthy volunteers. J Clin Enocrinol Metab. 2002; 87:1239–1246.

    Article  CAS  Google Scholar 

  52. Waugh N, Cummins E, Royle P, Clar C, Marie M, Richter B, et al. Newer agents for blood glucose control in type 2 diabetes: systematic review and economic evaluation. Health Technol Assess. 2010; 14 (36):1–248.

    Article  Google Scholar 

  53. National Prescribing Service. Newsletter. 56, 2008.

    Google Scholar 

  54. Yared Z, Chiasson JL. Ketoacidosis and the hyperosmolar hyperglycaemic state in adult diabetic patients. Diagnosis and treatment. Minerva Med. 2003;94(6):409–18.

    CAS  PubMed  Google Scholar 

  55. Magee MF, Bhatt BA. Management of decompensated diabetes: Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome. Crit Care Clin. 2001;17:75–106.

    Article  CAS  PubMed  Google Scholar 

  56. Gouni-Berthold I, Krone W. Diabetic ketoacidosis and hyperosmolar hyperglycaemic state. Med Klin (Munich). 2006;10:100–5.

    Google Scholar 

  57. Matz R. Management of the hyperosmolar hyperglycaemic syndrome. Am Fam Physician. 1999;60(5):1468–1476.

    CAS  PubMed  Google Scholar 

  58. Matz R. Hyperosmolar nonacidotic (HNAD). In Porte D, Sherwin RS, Ellenberg M, Rifkin H,eds Ellenberg and Rifkin’s Diabetes mellitus. 5th ed. Stamford, Conn: Appleton &Lange, 1997:845–60.

    Google Scholar 

  59. Matz R. How big is the risk of cerebral oedema in adults with DKA? J Crit Illn. 1996;11:768–72.

    Google Scholar 

  60. Vinik AI. Diagnosis and management of diabetic neuropathy. Clin Ger Med. 1999;15: 293–320.

    CAS  Google Scholar 

  61. King KD, Jones JD, Warthen J. Microvascular and macrovascular complications in diabetes mellitus. Amer J Pharm Edu. 2005;69 (5) Article 87.

    Google Scholar 

  62. Haffner SM . Reducing cardiovascular disease risk across the continuum of glucose tolerance. Medscape. Multispeciality. www.medscape.org/viewarticle/491058.

  63. Kisela BM, Khoury J, KLeindorfer D, Woo D, Schneider A, Anwell K, et al. Epidemiology of ischaemic stroke in patients with diabetes: the greater Cincinnati/Northern Kentucky Stroke Study. Diabetes Care/ 2005; 28:355–9.

    Article  Google Scholar 

  64. Stegmayr B, Asplund K. Diabetes as a risk factor for stroke. population perspective . Diabetologia. 1995; 30:736–43.

    Google Scholar 

  65. Hankey GJ. Stroke. Churchill Livingstone, Edinburgh, 2002.

    Google Scholar 

  66. Murabito JM, D’Agostino RB, Silbershatz H, Wilson WF. Intermittent claudication. A risk profile from the Framingham Heart Study. Circulation 1997;96:44–9.

    Article  CAS  PubMed  Google Scholar 

  67. Harris MI. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care. 1993;16:642–52.

    Article  CAS  PubMed  Google Scholar 

  68. National Diabetes Fact Sheet. National Center for Disease Prevention and Health Promotion. http://www.cdc.gov/diabetes/pubs/factsheet.htm accessed 20 April 2014.

  69. Kumar V, Cotran RS, Robbins SL. Basic Pathology. 5th Ed. WB Saunders Company, Philadelphia 1992.

    Google Scholar 

  70. Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus. Results of the HOPE study and MICRO-HOPE substudy. Lancet. 2000; 355:253–9.

    Article  Google Scholar 

  71. Martins D, Norris K. Combating diabetic nephropathy with drug therapy. Curr Diabetes Rep. 2001;1:148–56.

    Article  CAS  Google Scholar 

  72. Brenner BM, Cooper ME, Zeeuw D, Keane WF, Mitch MD, Parving HH, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001; 345:861–9.

    Article  CAS  PubMed  Google Scholar 

  73. Young MJ, Boulton, AJM, Macleod AF, Williams DR, Sonksen PH. A multicentric study of the prevalence of diabetic peripheral neuropathy in United Kingdom hospital clinic population. Diabetologia. 1993;36:150–4.

    Article  CAS  PubMed  Google Scholar 

  74. Tesfaye S. Epidemiology and etiology of diabetic peripheral neuropathy. Adv Stud Med. 2004; 4(10G: S1014–S1021).

    Google Scholar 

  75. Ziegler D, Gries FA, Spuler M, Lessmann F. The epidemiology of diabetic neuropathy, Diabetic Cardiovascular Autonomic Neuropathy Multicentre Group. J Diabetes Complications. 1992;6(1):49–59.

    Article  CAS  PubMed  Google Scholar 

  76. Thomas PK. Classification, differential diagnosis, and staging of diabetic peripheral neuropathy. Diabetes. 1997;46 Suppl 2;554–557.

    Google Scholar 

  77. Boulton AJM. Management of diabetic peripheral neuropathy. Clin Diabetes. 2005;23(1):9–15.

    Article  Google Scholar 

  78. Meneilly GS, Tessier D. Diabetes in elderly adults. J Gerentol Med Sci. 2001;56A:M5–M13.

    Article  Google Scholar 

  79. Mayo Climic .com. Diabetic neuropathy: symptoms, http://www.mayoclinic.com/health/diabetes-neuropathy/DSO1045/DSECTION=2 retrieved 20 June 2008.

  80. Aggarawal S, Toupay PS, Trikha S, Bansal A. Prevalence of autonomic neuropathy in diabetes mellitus. Curr Neurobiol. 2011;2(2):101–103.

    Google Scholar 

  81. Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26 (5):1553–79.

    Article  PubMed  Google Scholar 

  82. Niakan E, Hirato Y,Comstock JP. Diabetic autonomic neuropathy. Metabolism. 1986; 35 (3):724–34.

    Article  Google Scholar 

  83. Clarke BF, Ewing DJ, Campbell IW. Diabetic autonomic neuropathy. Diabetologia. 1979;17 (4):195–212.

    Article  CAS  PubMed  Google Scholar 

  84. Ewing DJ, Campbell IW, Clarke BF. The natural history of diabetic autonomic neuropathy. Q JM. 1980; 49(193): 95–108.

    CAS  Google Scholar 

  85. Bril V, England J, Franklin GM, Backomja M, Cohen JA, De Taro DR, et al. Evidence-based guidelines. Treatment of painful diabetic neuropathy. Neurology. 2011;76:1–1.

    Article  Google Scholar 

  86. Access my library. Pathophysiology of diabetic retinopathy. Optician.htp://www.accessmylibrary.com/coms2/summary _0286-18736025_ITM accessed 29 June 2008.

  87. Garner A. Developments in the pathology of diabetic retinopathy: a review. J Roy Soc Med. 1981;74: 427–431.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Liang JC, Goldberg MF. Diabetes. 1980; 29:841–851.

    Article  CAS  PubMed  Google Scholar 

  89. Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, et al. Diabetic Retinopathy. Diabetescave 2003; 26:S99–S102.

    Google Scholar 

  90. Luchsinger JA, Tang M, Stern Y, Shea Y, Maueux AR. Diabetes mellitus and risk of Alzheimer’s disease and dementia with stroke in a multiethnic cohort. Am J Epidemiol. 2001;154: 635–641.

    Article  CAS  PubMed  Google Scholar 

  91. Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, TaborHK, Schreiner PJ, et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2001; 6:32–38.

    Article  Google Scholar 

  92. Rodriguez-Pascual C, Rodriguez-Justo S, Garcia-Villar E, Narro-Vidal M, Torrente-Carballido M, Paredes-Galan E. Quality of life characteristics and metabolic control in diabetic geriatric patients. Maturitas 2011; 69(4):343–7.

    Article  CAS  PubMed  Google Scholar 

  93. Sinclair AJ, Gerling AJ, Bayer AJ. Cognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self management and use of services. Diab Res Clin Pract. 2000; 50:203–212.

    Article  CAS  Google Scholar 

  94. Tessier D, Avila-Funes JA, Aguikar-Navarro S. Diabetes and changes in functional status of the elderly: a reality? Rev Invest Clin. 2010; 62(4):318–22.

    PubMed  Google Scholar 

  95. Pasquier F, Boulogne A, Leys D, Fontaine P. Diabetes mellitus and dementia. Diabetes Metab. 2006; 32(5 Pt 1): 403–14.

    Article  CAS  PubMed  Google Scholar 

  96. Diabetic Care Services &Pharmacy. Effects of diabetes in the elderly. http://www.diabeticcareservices.com/diabetes-education/hypoglycaemia-andhyperglycaemia-and-the-elderly. Accessed 5 October 2015.

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2018). Diabetes Mellitus in the Elderly. In: Geriatric Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-33434-9_49

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33434-9_49

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33433-2

  • Online ISBN: 978-3-319-33434-9

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics