Treating diabtes in the elderly can be a challenge


More than one-quarter of all adults over age 65 have diabetes. But there is little research on how to treat the disease in older adults.

For decades, diabetes research has focused on working-age adults and children.

But there’s another group of people who are even more likely to have diabetes: the elderly. And doctors lack a strong understanding of how the disease affects their bodies.

The American Diabetes Association is hoping to change that.

The association recently convened a group of doctors and other experts to study the issue in greater depth. The fruit of their labor — a report titled “Diabetes in Older Adults: A Consensus Report” — will be published later this year in Diabetes Care and The Journal of the American Geriatrics Society.

“This is a major effort to address this challenge,” said Dr. Hermes Florez, a member of the committee and head of the division of epidemiology at the University of Miami Miller School of Medicine. “With life expectancy being five to 10 years more than before and the increased prevalence of this disease, we have to prepare ourselves.”

Diabetes is a metabolic disease characterized by high blood sugar. Individuals who have Type 1 diabetes are unable to produce insulin, the hormone that transports glucose from the bloodstream to the cells, where it is stored as energy. Individuals with Type 2 diabetes produce insulin, but are resistant to it.

The Centers for Disease Control and Prevention estimates that more than 25 percent of Americans over 65 have diabetes. More than half have pre-diabetes.

Those figures will likely rise over time. According to the ADA research paper, the number of cases of diagnosed diabetes in the elderly is projected to more than quadruple by 2050.

Why do older adults face such a high risk of developing diabetes?

For one, the body becomes more resistant to insulin with age, according to the report. What’s more, the part of the pancreas that synthesizes insulin functions less effectively over time.

“The mean age of the patients I see is about 80,” said Florez, who is also the deputy director of the Geriatrics Research Education and Clinical Center within the Miami VA Healthcare System. “Some of them are quite functional and very proficient. Others are very frail.”

Diabetes can cause a myriad of complications. The ADA report found that older adults who have diabetes are at a higher risk of limb amputations, heart attacks, vision problems and kidney failure than diabetes patients in any other age group. The risk grows even higher for patients over 75.

Additionally, older adults with diabetes are twice as likely as other older adults to have cognitive problems like Alzheimer’s disease and dementia, according to the paper. They face a higher risk of depression, hearing and vision problems, as well as falling.

“That could be a devastating event leading to a hip fracture and a prolonged rehabilitation,” Florez said.

Still, questions linger about how to treat diabetes in older patients, largely because little research has been done.

“The exclusion of older, and especially frail older, participants from most traditional randomized controlled trials of diabetes interventions has left us with large gaps in our knowledge of how best to address diabetes in the age-group with the highest prevalence rates,” the research group wrote in its report.

Florez said older adults may have been left out of the clinical research because the pharmaceutical companies wanted to avoid possible complications. In addition, few geriatric specialists and researchers were trained to look out for diabetes, he said.

Prevention is possible, according to the report.

Type 2 diabetes can be prevented or delayed by healthy eating and exercise, and by some forms of medication. The American Diabetes Association suggests all overweight adults older than 45 be screened at least every three years.

Once a diagnosis is made, treating diabetes in older adults can be a challenge. Older patients tend to eat less, so it is difficult to control the disease through diet modification. Treating the disease can be even more challenging for older adults living in a nursing home, where meals can be erratic and there are high levels of employee turnover.

Researchers are working on studies that will address some of those questions.

At the VA hospital in Miami, older patients are tracking their blood sugar, blood pressure and physical activity, and sending that information back to doctors, Florez said.

Florez has been training some older adults to teach their peers about lifestyle modifications.

One of his patients at the University of Miami’s Diabetes Research Institute is Jose Belaval, a 79-year-old resident of Cutler Bay.

Belaval was diagnosed with Type 2 diabetes more than a decade ago, he said. He controls the disease by taking an oral diabetes medication called Januvia and paying attention to what he eats.

“You have to eat right,” Belaval said, noting that he lost 30 pounds by trimming carbohydrates from his diet.

Belaval is diligent about monitoring his blood sugar levels, and checking his vision and hearing. He keeps track of the data. And Florez often has him perform a short physical performance battery exam that includes balance and speed tests.

Belaval believes it is his duty to be part of the research on older adults with the condition.

“In a way, my experience will help other people,” he said. “That’s very important.”

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