|Panel Finds Critical Gaps in Evidence for Those 65 and Older
Adults age 65 and older are more likely to have diabetes than any other age group, but researchers and clinicians have the least amount of data regarding how best to treat this population, a consensus report published jointly by the American Diabetes Association and American Geriatrics Society concludes.
The report, written by a Consensus Panel of diabetes experts from multiple disciplines, will be published simultaneously online Oct. 25 in Diabetes Care and in the Journal of the American Geriatrics Society. The report outlines what diabetes experts know about older adults with diabetes, how the disease affects them differently than younger adults, what can be done to prevent or treat it and how best to fill the critical gaps in evidence to better address their needs.
“With our nation’s aging population, it becomes increasingly important for us to understand how diabetes is impacting older adults,” said Geralyn Spollett, MSN, ANP-CS, CDE, President, Health Care & Education, American Diabetes Association. “We know a great deal about how to help middle-aged adults prevent and manage diabetes, but little about those in their later years, who are far more likely to be diagnosed and to suffer from the serious and life-threatening complications associated with this disease.”
In February, 2012, the American Diabetes Association convened a Consensus Development Conference on Diabetes and Older Adults (defined as those aged 65 years or older) to hear from researchers and other experts on what is known, and not known, about this population. The consensus report highlights what was learned in the following areas: the epidemiology and pathogenesis of diabetes in older adults; evidence for preventing and treating diabetes and its most common comorbidities in older adults; current guidelines for treating older adults with diabetes; issues that need to be considered in individualizing treatment recommendations; consensus recommendations for treating older adults with or at risk for diabetes; and how gaps in the evidence can be filled.
“One important issue is that older people are a very heterogeneous population, which means that recommendations cannot simply be based on age. One 75-year-old may have newly diagnosed diabetes but otherwise be quite healthy and lead a very active life, while another may have multiple diseases, dementia and longstanding diabetes with complications. It’s critical to consider overall physical and cognitive function, quality of life and patient preferences when developing a treatment plan with an older patient,” said Jeffrey B. Halter, MD, a member of the consensus panel, director of the Geriatrics Center at the University of Michigan, and past president of the American Geriatrics Society.
As people get older, insulin resistance increases and pancreatic islet cell function decreases, placing them at greater risk for the development of type 2 diabetes. The epidemic of type 2 in the United States, while clearly associated with the increase in overweight and obesity, is also greatly exacerbated by the aging of the population. In fact, the Centers for Disease Control and Prevention estimates that, even if diabetes incidence leveled off, prevalence rates would still double over the next 20 years as our population ages.
More than 25 percent of adults age 65 or older have diabetes, and roughly half have prediabetes. Older adults with diabetes also have the highest rate of diabetes-related lower limb amputations, heart attacks, vision problems and kidney failure of any other age group, with rates higher even still for those over the age of 75. Yet, the report noted, this group has not been included in most diabetes treatment trials, particularly those with comorbidites or cognitive impairment.
The panel, when developing consensus recommendations for clinical care, used a framework of considering older adults with diabetes in one of three groups: those in relatively good health; those with complex medical histories that might make self-care difficult; and those with significant comorbid illness and functional impairment, with different screening and treatment recommendations for each group. It also recommended further research be done that takes into account the complexity of issues facing older adults and that studies include patients with multiple comorbidities, dependent living situations and geriatric syndromes to get the most complete picture of the needs and challenges of frail or complex patients.
The American Diabetes Association Consensus Development Conference was supported by a planning grant from the Association of Specialty Professors (through a grant from the John A. Hartford Foundation), by Educational Grants from Lilly USA, LLC and Novo Nordisk Inc., and sponsorships from the Medco Foundation and Sanofi.
Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into one of the nation’s leading causes of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations.