Diabetes up among elderly

A study published earlier this year in the Archives of Internal Medicine reported some scary news: More older U.S. adults are getting diabetes. From the mid-90s to the mid-2000s, the number of people older than 65 diagnosed with diabetes rose 23%.

The study included more than 100,000 people over age 65 who had been recently diagnosed with diabetes. Researchers compared such individuals from the mid-1990s with those in 2003 and 2004. Here's what they found:

• The incidence of diabetes (number of new cases per year) increased by 23%.
• The prevalence of diabetes (total number of cases, including new and old) increased by 62%.
• Nearly 90% of these older people with diabetes had one or more other health problems. These included heart disease, eye problems, kidney disease or nerve damage.
• The overall rates of these additional problems were unchanged or rose in the last decade.

Here, my colleague, Dr. Rob Shmerling, comments on these study results:

Not all of the findings of this study were so discouraging. Eye problems from diabetes were actually lower in 2003-2004, compared with the mid-1990s. The death rate among elderly diabetics fell more than 8% since the mid-1990s.

In addition, some of the increase in diabetes among the elderly may be a result of better health care. We are more likely to develop diabetes as we get older, so, advances that allow people to live longer might contribute to a rise in new cases of diabetes.

Part of the increase could be the result of changes in the definition of diabetes. In particular, the fasting blood sugar used to diagnose diabetes was lowered in 1997. The old number was 140 milligrams per deciliter (mg/dl). The current number is 126 mg/dl.

Still, it's likely that most of the increase in diabetes among the elderly is due to excess weight. The bad news is that the health burden of this trend is enormous.

The good news is that the trend can be reversed. We know a lot about how to detect and treat diabetes. We also know how to detect and treat other health problems caused by diabetes. We know that weight loss can prevent diabetes, make it easier to treat or even put the disease into remission.

What can you do? 

Two factors are most closely linked to a higher risk of diabetes—aging and weight gain. Only one is avoidable. So everyone—regardless of age—should focus their efforts on avoiding weight gain. Here are some things you can do: 

• Check your body mass index (BMI) and waist size regularly. Although these are not perfect indicators of a healthy weight, they're a good guide for most people. Aim for a BMI of 19.0 to 24.9. Women should aim for a waist size of 35 inches or less. For men, 40 inches or less is a reasonable target.
• Think about what you're eating. Choose a balanced diet that includes a mix of carbohydrates, protein and healthy fats. Pay attention to portion size and total calories.
• Commit to becoming more active, especially if you are sedentary now. Start slowly. Gradually increase how much you walk each day. Work with your doctor, physical therapist, or trainer to come up with an exercise program you enjoy.
• Get your blood sugar checked. If it is slightly high, but not high enough for the diagnosis of diabetes, take action. Diet, exercise, and medicines may help you to avoid the disease.
• If you are obese and have health problems related to excess weight (including diabetes), consider weight loss surgery. It can bring huge health benefits. However, this is usually a treatment option of last resort.

 Are you an older person living with diabetes, or do you know someone who is? Tell us your story.

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Living Better, Living Longer
Today, 85-94 year olds are the fastest growing segment of the population, followed by people age 95 and older. Whether you eventually join that club depends upon how healthy, active, and alert you stay as the years go by. Living Better, Living Longer is a special health report from Harvard Medical School designed to help you avoid common health woes of aging, such as heart disease, stroke, Alzheimer's disease, and sight and hearing disorders. From diet and exercise to sexuality, you'll find tips to enhance life and help with planning for whatever the future brings.

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