Sunday, September 9, 2007

Diabetes - Aging


According to the American Diabetes Association, approximately 18.3% (8.6 million) of Americans age 60 and older have diabetes. Diabetes mellitus prevalence increases with age, and the numbers of older persons with diabetes are expected to grow as the elderly population increases in number. The National Health and Nutrition Examination Survey (NHANES III) demonstrated that, in the population over 65 years old, almost 18% to 20% have diabetes.

Regarding another study more than 40% of Americans 65 yr and older meet diagnostic criteria for type 2 diabetes or IGT impaired glucose tolerance. Older Americans are also more likely to have complicating conditions such as retinopathy, hypertension, and kidney problems.

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. Glucose tolerance progressively declines with age, and there is a high prevalence of type 2 diabetes and postchallenge hyperglycemia in the older population. Age-related glucose intolerance in humans is often accompanied by insulin resistance, but circulating insulin levels are similar to those of younger people.

Researchers and clinicians agree that treatment goals for older patient with diabetes 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.Following evaluation, one of two levels of care can be recommended: symptom-preventing care or aggressive care. The decision is made jointly by the patient and the primary caregiver. [