Diabetes and Altered Glucose Metabolism with Aging

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Key points

  • 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

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.

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    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.

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