related to a particular health issue
More people are living into their seventies, eighties, and nineties,
and diabetes is on the upswing in this population. As is the case
in younger groups, type 2 diabetes is sometimes preventable, but
certain group-specific characteristics present new challenges
to health care professionals treating older people with diabetes.
many older people have diabetes?
More than half of the 16 million Americans estimated to have diabetes
are over age 60. Of those over age 65, almost 1 in 5 has diabetes,
mostly type 2. In groups at increased risk of type 2 diabetes,
the proportion is even higher: Almost 1 in 3 older Hispanics and
African Americans and 3 out of 4 Pima Indian elders have diabetes.
is different for older people with diabetes?
The way diabetes is managed changes with age. Insulin production
decreases because of the age-related impairment of pancreatic
beta cells. Insulin resistance increases due to the loss of lean
tissue and the accumulation of fat, particularly intra-abdominal
fat, and the decreased tissue sensitivity to insulin.
addition, other factors can affect diabetes management in older
Modifying lifestyle risk factors associated with type 2 diabetes,
such as obesity, poor diet, smoking, and lack of exercise, may
be more difficult for older people. Lack of means and access may
restrict nutritional improvement, the decline in physical abilities
may make exercise difficult, and years of smoking may make quitting
conditions, such as hypertension, increase the challenge of treating
diabetes in older people. Further, diabetes can exacerbate the
symptoms of coexisting conditions. Taking various medications
for multiple conditions, called polypharmacy, increases the risk
of adverse drug interactions. Diabetes complications can develop
quickly in older people, often as a result of the long period
before diagnosis. In addition, older people may have more complications,
which may be more severe, than younger people.
physical and/or mental abilities may make it difficult to follow
a treatment regimen. Limited financial resources may affect the
choice and use of medication.
are the treatment goals for older people with diabetes?
The treatment goals are the same for everyone who has diabetes--to
enhance quality of life and reduce diabetes complications. Older
people with diabetes are a heterogeneous group, encompassing those
who are active and healthy as well as people who are frail and
disabled. Researchers and clinicians agree that treatment goals
need to be individualized and take into account health status,
as well as life expectancy, level of dependence, and willingness
to adhere to a treatment regimen. Nutrition therapy is usually
a good starting point. Most patients can be advised to adopt some
form of regular exercise and to take oral agents. Many will also
be able to inject insulin, but intensive management may not be
possible or advisable.
is NIDDK doing to study diabetes in older people?
NIDDK supports research into the mechanisms and effects of type
2 diabetes in older people at both the scientific and clinical
levels. Scientific research topics include insulin signal transduction
and changes in insulin receptors.
consistent with the study method, clinical trials are being designed
to include more older people with diabetes. The Diabetes Prevention
Program was designed to evaluate the efficacy of a lifestyle intervention
and a pharmacological intervention in preventing or delaying type
2 diabetes in people with impaired glucose tolerance, a risk factor
for type 2 diabetes. Of the 3,234 participants, 20 percent were
over age 60.
older adults at high risk, the study showed that modifying lifestyle
with a low-calorie, low-fat diet and moderate regular exercise
can delay the onset of type 2 diabetes.
can I get information about exercise and older adults?
The National Institute on Aging (NIA), part of the National Institutes
of Health, has educational materials on exercise for older adults.
Exercise: A Guide From the National Institute on Aging is a free,
science-based guide to safe, effective exercise programs for older
adults. It is also available in Spanish.
obtain a copy of the award-winning guidebook, as well as other
materials, contact the NIA Information Center at 1-800-222-2225
or visit the NIA website at www.nih.gov/nia.
NDIC Booklet Provides General Guide to Diabetes
guide to diabetes: type 1 and type 2, now available from NDIC,
describes what diabetes is and how to take care of it. Written
at an eighth-grade reading level, the illustrated publication
summarizes steps for daily care, procedures to follow when blood
glucose levels are high or low, how to prevent or delay long-term
complications, management of diabetes during special times (during
sick days, travel, school or work, or pregnancy), and additional
publication, an update of the NDIC booklet Do Your Level Best,
provides target levels for the A1C test and daily blood glucose
self-monitoring and a reproducible "daily diabetes record
page" for recording blood glucose readings, medication dosages
and times, and special events. The latest recommendations for
target blood pressure and cholesterol levels are also included.
Use the online
catalog to order a printed copy.
of National Diabetes Information Clearinghouse