- •
Adults aged 60 and over have more than twice the prevalence of diabetes compared with younger age groups. The number of older persons with diabetes will continue to grow as the population ages.
- •
Abnormal glucose metabolism is associated with aging but is not a necessary component.
- •
Older persons with diabetes and/or abnormal glucose metabolism may be at higher risk of developing adverse geriatric syndromes, such as accelerated muscle loss, functional disability, and frailty.
- •
Goals of care for older
Diabetes and Altered Glucose Metabolism with Aging
Section snippets
Key points
Epidemiology of diabetes and impaired glucose states with aging
Diabetes in older adults is a growing public health concern, with almost one-third of US adults over the age of 60 years having diabetes, of whom approximately half are undiagnosed; an additional one-third of older adults have prediabetes.1 Diabetes prevalence in older adults is more than twice that of middle-aged adults.1 It is projected that the numbers of elderly persons will approximately double by the year 2030.2, 3 In addition, the number of people in nursing homes with diabetes continues
Altered glucose metabolism with aging
Using hyperinsulinemic-euglycemic clamp methodology as a method for quantification of insulin effectiveness in regulating glucose transport into tissues, whole-body insulin sensitivity is demonstrably reduced in older versus younger adults.13, 14 Impaired intracellular whole-body rates of glucose oxidation in elderly versus young adults have also been reported.15 Potential explanations for reduced insulin effectiveness with aging include (1) increased abdominal fat mass, (2) decreased physical
Complications of diabetes in the elderly
Microvascular and macrovascular complications of diabetes occur in older patients, similar to younger persons, although the absolute risk of cardiovascular disease is much higher in older adults.30 Diabetes in the older adult population, however, is heterogeneous and includes individuals with both middle age–onset and elderly-onset diabetes,31 with the latter group accounting for up to one-third of older adults with diabetes. Middle age–onset adults may have worse glycemic control and are more
Geriatric syndromes associated with diabetes
Descriptions of otherwise healthy centenarians without impaired glucose uptake suggest that insulin resistance is not a necessary component of the aging process.33, 34 Instead, older adults with abnormal glucose status and diabetes likely represent a vulnerable subset at high risk for adverse outcomes. Geriatric syndromes that have been described to occur more frequently in persons with diabetes include loss of muscle function, functional limitations and disability, and frailty—all of which can
Guidelines
The goals of diabetes care in older patients with diabetes include (1) control of hyperglycemia, (2) prevention and treatment of macrovascular and microvascular complications of diabetes, (3) avoidance of hypoglycemia, and (4) preservation of quality of life. Although the goals are similar to those in younger adults, older adults with diabetes are heterogeneous in their physical and cognitive functioning capacity, multiple comorbidities, and life expectancy. Otherwise robust older adults with
Summary
Diabetes and altered glucose metabolism commonly occur with aging. OGTT may help characterize abnormal glucose status in the elderly population. Diabetes in this population is heterogeneous, with middle age–onset versus elderly-onset individuals possibly representing groups at different risks for the development of microvascular complications. Geriatric syndromes, such as muscle loss, disability, and frailty, are more prevalent in older patients with diabetes and may be related to the presence
Acknowledgments
We thank David Liu (National Institute on Aging) for help with Fig. 2 illustration.
References (104)
- et al.
Trends in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995-2004
J Am Geriatr Soc
(2010) The effect of aging on carbohydrate metabolism
Metabolism
(1979)- et al.
Role of impaired intracellular glucose metabolism in the insulin resistance of aging
Metabolism
(1992) - et al.
Frailty in the elderly is associated with insulin resistance of glucose metabolism in the postabsorptive state only in the presence of increased abdominal fat
Exp Gerontol
(2009) - et al.
The effect of age on insulin response and glucose utilization during four hyperglycemic plateaus
Exp Gerontol
(1993) - et al.
Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study
Lancet
(2009) - et al.
Handgrip strength and insulin levels: cross-sectional and prospective associations in the Normative Aging Study
Metabolism
(1997) - et al.
Gait pattern alterations in older adults associated with type 2 diabetes in the absence of peripheral neuropathy—results from the Baltimore Longitudinal Study of Aging
Gait Posture
(2011) - et al.
Frailty, hospitalization, and progression of disability in a cohort of disabled older women
Am J Med
(2005) - et al.
Effect of age and frailty on ghrelin and cholecystokinin responses to a meal test
Am J Clin Nutr
(2009)
Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006
Diabetes Care
Centers for Disease Control and Prevention (CDC). Public health and aging: trends in aging—United States and worldwide
JAMA
Global prevalence of diabetes: estimates for the year 2000 and projections for 2030
Diabetes Care
Age as an independent determinant of glucose tolerance
Diabetes
Glucose intolerance and aging
Diabetes Care
Insulin action and age. European Group for the Study of Insulin Resistance (EGIR)
Diabetes
Glucose tolerance, glucose utilization and insulin secretion in ageing
Novartis Found Symp
Carbohydrate metabolism in the elderly
Eur J Clin Nutr
Standards of medical care in diabetes—2012
Diabetes Care
The natural history of progression from normal glucose tolerance to type 2 diabetes in the Baltimore Longitudinal Study of Aging
Diabetes
Glucose clamp technique: a method for quantifying insulin secretion and resistance
Am J Physiol
Glucose intolerance and aging: evidence for tissue insensitivity to insulin
Diabetes
The role of dietary carbohydrate in the decreased glucose tolerance of the elderly
J Am Geriatr Soc
The effect of age on insulin resistance and secretion: a review
Semin Nephrol
Twenty-four-hour profiles and pulsatile patterns of insulin secretion in normal and obese subjects
J Clin Invest
Alterations in the ultradian oscillations of insulin secretion and plasma glucose in aging
Diabetologia
Disruption of the pulsatile and entropic modes of insulin release during an unvarying glucose stimulus in elderly individuals
J Clin Endocrinol Metab
Lack of control by glucose of ultradian insulin secretory oscillations in impaired glucose tolerance and in non-insulin-dependent diabetes mellitus
J Clin Invest
The role of incretins in glucose homeostasis and diabetes treatment
Pharmacol Rev
The enteric enhancement of glucose-stimulated insulin release. The role of GIP in aging, obesity, and non-insulin-dependent diabetes mellitus
Diabetes
The effect of age and glycemic level on the response of the beta-cell to glucose-dependent insulinotropic polypeptide and peripheral tissue sensitivity to endogenously released insulin
J Clin Endocrinol Metab
Exogenous glucose-dependent insulinotropic polypeptide worsens post prandial hyperglycemia in type 2 diabetes
Diabetes
Effect of ageing and diabetes on glucose-dependent insulinotropic polypeptide and dipeptidyl peptidase IV responses to oral glucose
Diabet Med
Management of diabetes mellitus in the elderly
Curr Opin Endocrinol Diabetes Obes
The burden and treatment of diabetes in elderly individuals in the U.S
Diabetes Care
Clinical analysis of elderly patients with elderly-onset type 2 diabetes mellitus in China: assessment of appropriate therapy
J Int Med Res
Age-related insulin resistance: is it an obligatory finding? The lesson from healthy centenarians
Diabetes Metab Res Rev
Glucose tolerance and insulin action in healty centenarians
Am J Physiol
Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study
Diabetes
Health, aging, and body composition study. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study
Diabetes Care
Health, aging, and body composition study. Excessive loss of skeletal muscle mass in older adults with type 2 diabetes
Diabetes Care
Insulin resistance is associated with decreased quadriceps muscle strength in nondiabetic adults aged ≥70 years
Diabetes Care
Glucose and insulin measurements from the oral glucose tolerance test and relationship to muscle mass
J Gerontol A Biol Sci Med Sci
Insulin resistance of muscle protein metabolism in aging
FASEB J
The response of muscle protein anabolism to combined hyperaminoacidemia and glucose-induced hyperinsulinemia is impaired in the elderly
J Clin Endocrinol Metab
Insulin resistance accelerates muscle protein degradation: activation of the ubiquitin-proteasome pathway by defects in muscle cell signaling
Endocrinology
Insulin sensitizers may attenuate lean mass loss in older men with diabetes
Diabetes Care
Lower intrinsic ADP-stimulated mitochondrial respiration underlies in vivo mitochondrial dysfunction in muscle of male type 2 diabetic patients
Diabetes
Opposite effects of pioglitazone and rosiglitazone on mitochondrial respiration in skeletal muscle of patients with type 2 diabetes
Diabetes Obes Metab
Sensory and motor peripheral nerve function and lower-extremity quadriceps strength: the health, aging and body composition study
J Am Geriatr Soc
Cited by (132)
Contributions of mouse genetic strain background to age-related phenotypes in physically active HET3 mice
2024, Neurobiology of AgingReproductive risk factors across the female lifecourse and later metabolic health
2024, Cell MetabolismUnderstanding the aging hypothalamus, one cell at a time
2022, Trends in Neurosciences
Funding Sources: This work is supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases (R.R. Kalyani; K23DK093583) and the Intramural Research Program/National Institutes of Health, and the National Institute on Aging (J.M. Egan).
Conflict of Interest: None.