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Health & Medicine for Senior Citizens

Older Adults with Diabetes Live Long Enough to Benefit from Interventions

‘…with the exception of patients over age 76 with the poorest health status, all showed strong survival rates’ - U-M study

May 2, 2012 - Middle-aged and older adults with diabetes showed substantial survival rates in a new University of Michigan Health System study of retirees. Survival rates were strong even for adults living in nursing homes or who have multiple health issues like dementia and disabilities that make self-managed care for diabetes difficult.

The findings were published in the Journal of Gerontology and revealed even older adults may benefit from interventions that can prevent or delay the complications of diabetes, which include poor vision, nerve damage, heart disease and kidney failure.

 

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“We went into this thinking that people in the limited health group would have substantial mortality but with the exception of patients over age 76 with the poorest health status, all showed strong survival rates,” says lead study author Christine T. Cigolle, M.D., M.P.H., an assistant professor of family medicine and internal medicine at the U-M Medical School and research scientist at the VA.

There is no cure for diabetes, but those with type 2 diabetes can prevent complications through regimens that may involve multiple medications and changes in diet and physical activity.

Cigolle, who is also a research assistant professor at the U-M Institute of Gerontology, notes that the success of these interventions depends on the patient’s ability to self-manage their diabetes and on surviving long enough to experience benefits of treatment.

The study found that while adults in the older age groups were more likely to have difficulty managing the disease and to have poor health status, middle-aged adults constituted the largest number of diabetes patients to have self-management difficulties.

Blindness, cognitive impairment and having multiple diseases requiring multiple medications were among issues that complicated their ability to manage their diabetes.

The finding that medically complex patients survive to five years also supports inclusion of older patients in clinical trials to determine whether their outcomes replicate those of younger, healthier diabetes patients.

“A struggle in geriatrics has been what interventions are appropriate for older adults,” says the study senior author Caroline S. Blaum, M.D., M.S., professor of internal medicine and geriatrics at the U-M Health System.

“The fact that this group is showing substantial survival means they may well be candidates for continued aggressive care.”

The research was based on nationally representative data from the U-M Health and Retirement Study.


Funding: National Institute on Aging, National Institutes of Health; the Claude D. Pepper Older Americans Independence Center at the University of Michigan; the John A. Hartford Foundation Center of Excellence in Geriatrics at the University of Michigan; and the Ann Arbor VA Geriatric Research, Education and Clinical Center (GRECC).

Additional authors: Pearl G. Lee, M.D.; and Mohammed U. Kabeto, M.A. both of U-M.

Citation: “Clinical Complexity and Mortality in Middle-Aged and Older Adults with Diabetes,” Journal of Gerontology, A Biol Sci Med Sci; 10.1093/Gerona/gls095.


About Type 2 Diabetes and Older People

By NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Diabetes means your blood glucose, or blood sugar, is too high. With Type 2 diabetes, the more common type, your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your heart, eyes, kidneys, nerves, gums and teeth.

You have a higher risk of type 2 diabetes if you are older, obese, have a family history of diabetes, or do not exercise.

The symptoms of type 2 diabetes appear slowly. Some people do not notice symptoms at all. The symptoms can include

   ● Being very thirsty

   ● Urinating often

   ● Feeling very hungry or tired

   ● Losing weight without trying

   ● Having sores that heal slowly

   ● Having blurry eyesight

A blood test can show if you have diabetes. Many people can manage their diabetes through healthy eating, physical activity, and blood glucose testing. Some people also need to take diabetes medicines.

Should I be tested for diabetes?

Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and overweight-see the BMI chart -getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more of the risk factors, you should consider getting tested. Ask your doctor for a fasting blood glucose test or an oral glucose tolerance test. Your doctor will tell you if you have normal blood glucose, prediabetes, or diabetes.

   ● Among U.S. residents ages 65 years and older, 10.9 million, or 26.9 percent, had diabetes in 2010.

   ● Diabetes affects 25.8 million people of all ages - 8.3 percent of the U.S. population
       > DIAGNOSED - 18.8 million people
       ●> UNDIAGNOSED - 7.0 million people

   ● About 215,000 people younger than 20 years had diabetes—type 1 or type 2—in the United States in 2010.

   ● About 1.9 million people ages 20 years or older were newly diagnosed with diabetes in 2010 in the United States.

   ● In 2005–2008, based on fasting glucose or hemoglobin A1C (A1C) levels, 35 percent of U.S. adults ages 20 years or older had prediabetes - 50 percent of adults ages 65 years or older. Applying this percentage to the entire U.S. population in 2010 yields an estimated 79 million American adults ages 20 years or older with prediabetes.

   ● Diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputations, and new cases of blindness among adults in the United States.

   ● Diabetes is a major cause of heart disease and stroke.

   ● Diabetes is the seventh leading cause of death in the United States.

 

 

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