Diabetes in Older Adults

Diabetes in Older Adults

How Common Is Diabetes in Older Adults?  

Diabetes is a chronic condition that affects over 10% of the global population and disproportionally affects older adults.1,2 It is estimated that more than 25% of people over 65 years of age have diabetes and that more than 50% of older adults are affected by prediabetes, with older adults developing diabetes nearly three times faster than younger adults.3


What Causes Diabetes in Older Adults?

Diabetes is known to be an age-related metabolic disorder.4 Combined effects of age-related physiological changes, genetic factors, and lifestyle factors are thought to put older adults at a greater risk of developing type 2 diabetes mellitus (T2DM).3,5,6 Diabetes in older adults is generally understood as being either an incident diabetes (diagnosed after the age of 65) or long-standing diabetes (diagnosed in middle age or earlier).5


Aging – Aging has shown to affect pancreatic b-cell’s capacity to function properly.3 Total mass of b-cells is shown to only moderately decrease over time, and autoimmune destruction of b-cells – characteristic of type 1 diabetes mellitus – is rarely seen. However, various studies have shown that aging impairs pancreatic b-cell regeneration and adaptation to insulin resistance, causing insulin secretion to be impaired with age.3


ObesityAlthough aging does play a role in the development and progression of diabetes in older adults, obesity-related factors are understood to play a more significant role.3,6 More than 35% of older adults in the U.S. are considered obese, and gains in intraabdominal fat are thought to particularly contribute to insulin resistance in older adults. A sedentary lifestyle, reduced physical activity, poor diet, and age-related physiological ages are known to cause weight gain and loss of muscles in older adults.  


InflammationInflammation is known to be implicated in various metabolic disorders, and it is not an exception for diabetes in older adults.3 Obesity- and age-related low-grade inflammation are shown to increase the risk of T2DM in older adults.


Comorbidities – Older adults have a higher risk of developing other comorbidities and are often affected by other chronic illnesses.3 For instance, high blood pressure (ie, hypertension) commonly affects older adults and is known to affect insulin sensitivity. In addition, acute illnesses more common in older adults can cause spikes in stress hormone levels, which can trigger hyperglycemic events. Polypharmacy, or the use of multiple medications, is especially common in older adults and is known to increase the risk of inducing insulin resistance and of worsening hyperglycemia in diabetes.7–9


How Is Diabetes Managed in Older Adults?

Diabetes comes with a greater risk of complications in older adults and should be managed accordingly.5 For instance, older adults with diabetes are known to have the highest rates of amputation, heart attack, impaired vision, and end-stage renal disease among all age groups. This risk increases with age even among the older adult population. In addition to complications, older adults have a higher risk of hypoglycemic episodes as well as greater risk of death from hyperglycemic crises.  


Lifestyle Interventions – Lifestyle interventions such as engaging in physical activity, eating a healthier diet, and losing mild to moderate amounts of weight can be important in preventing and treating diabetes and hyperglycemia in older adults.3 Increasing physical activity can reduce insulin resistance and improve glycemic control in older adults with diabetes. However, it should be noted that changes to physical activity should only be implemented based on the individual’s frailty status.2 Thus, adequate protein consumption and appropriate weightbearing resistance exercises are particularly recommended in older adults.


Medications – Pharmacological therapy for diabetes is common, but should be approached with care in older adults.2 Glycemic goals should be individualized in older adults based on comorbidities and cognitive function, and the risk of hypoglycemia should be weighed when choosing glycemic targets. Older adults are often subject to overtreatment and polypharmacy, and thus complex diabetes treatment plans should be simplified in older adults to lower burden of polypharmacy as well as the risk of hypoglycemia. Additionally, medications should be chosen while considering the risk for other chronic conditions, choosing agents that lower risk of heart and kidney disease when applicable. 

1. Magliano DJ, Boyko EJ; IDF Diabetes Atlas 10th edition scientific committee. IDF DIABETES ATLAS [Internet]. 10th edition. Brussels: International Diabetes Federation; 2021. Chapter 3, Global picture. Available from: https://www.ncbi.nlm.nih.gov/books/NBK581940/.
2. American Diabetes Association Professional Practice Committee. 13. Older Adults: Standards of Care in Diabetes—2024. Diabetes Care. 2023;47(Supplement_1):S244-S257. doi:10.2337/dc24-S013
3. Lee PG, Halter JB. The Pathophysiology of Hyperglycemia in Older Adults: Clinical Considerations. Diabetes Care. 2017;40(4):444-452. doi:10.2337/dc16-1732
4. ElSayed NA, Aleppo G, Aroda VR, et al. 13. Older Adults: Standards of Care in Diabetes—2023. Diabetes Care. 2022;46(Supplement_1):S216-S229. doi:10.2337/dc23-S013
5. Kirkman MS, Jones Briscoe V, Clark N, et al. Diabetes in Older Adults. J Am Geriatr Soc. 2012;60(12):2342-2356. doi:10.1111/jgs.12035
6. Chentli F, Azzoug S, Mahgoun S. Diabetes mellitus in elderly. Indian J Endocrinol Metab. 2015;19(6):744-752. doi:10.4103/2230-8210.167553
7. Alwhaibi M, Balkhi B, Alhawassi TM, et al. Polypharmacy Among Patients with Diabetes: A Cross-Sectional Retrospective Study in a Tertiary Hospital in Saudi Arabia. BMJ Open. 2018;8(5):e020852. doi:10.1136/bmjopen-2017-020852
8. Remelli F, Ceresini MG, Trevisan C, Noale M, Volpato S. Prevalence and Impact of Polypharmacy in Older Patients with Type 2 Diabetes. Aging Clin Exp Res. 2022;34(9):1969-1983. doi:10.1007/s40520-022-02165-1
9. Dobrică EC, Găman MA, Cozma MA, Bratu OG, Pantea Stoian A, Diaconu CC. Polypharmacy in Type 2 Diabetes Mellitus: Insights from an Internal Medicine Department. Medicina (Kaunas). 2019;55(8):436. doi:10.3390/medicina55080436



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