Type 2 Diabetes in the Elderly People

This paper aims at discussing type 2 diabetes among the elderly, its causes, effects, diagnosis, treatment and management. Diabetes mellitus is expected to increase as life expectancy and the aging generation increase. Apart from diabetes, CVDs and geriatric syndromes are rising complications among the older people.

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Title: Type 2 Diabetes in the Elderly People

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Abstract
About 30 percent of the age above 65 years in the US are suffering from diabetes
mellitus. This is because aging is driver to diabetes. Mostly diabetes is described on the basis
of its consequences on the patient (mostly the working class), among the older generation it is
associated with high mortality rate and low body activity. The elderly people suffering from
diabetes mellitus are at a high risk of contracting the CVDs and other chronic infections.
Diabetes mellitus is expected to increase as life expectancy and the aging generation increase.
Apart from diabetes, CVDs and geriatric syndromes are rising complications among the older
people. Both in the younger and elderly patients, treatment of diabetes involves
hyperglycemia and risk factors. The treatment of diabetes should be individualized and take
in to consideration functional limitations and comorbid diseases. Hypotension, hypoglycemia
and drug interactions should be highly avoided in the treatment of elderly diabetes patients.

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According to Dorrington & Bowdish (2013), the innate and adaptive changes in
immunity that occur as one ages are associated with the increased infections in the elderly.
The leukocyte produced on the bone marrow is biased towards the myeloid cells to the
neglect of naïve lymphocytes (Montgomery & Shaw, 2015). The reduced T cell and thymus
outputs are thought to be a cause of the reduced novel infections among the elderly (Geiger,
de Haan and Florian, 2013). The changes in B cells also contribute to the reduced response to
infections among the old as it alters the de novo antibody response (Aberle, Stiasny, Kundi
and Heinz, 2012). This raises the alarm for the clinicians and nurses to develop sensitivity
towards the needs of this generation. A study carried out in the United States between 1995
and 2004 shows that type 2 diabetes (T2DM) has increased from 16 percent to 23 percent
(Zhang, Decker, Luo, Geiss, Pearson, Saaddine, Gregg and Albright, 2010). For the current
generation, between 22 percent and 33 percent of the people above 65 years of age are
diagnosed with diabetes. It is also predicted that this number would increase by 4.5 times
before 2050 (Kirkman, Briscoe, Clark, Florez and Halter, 2012). This paper aims at
discussing type 2 diabetes among the elderly, its causes, effects, diagnosis, treatment and
management.
As age progresses, there is increased intolerance to glucose leading to the more
diabetes cases. Reduced B cell compensating capacity for the elderly generation leads to
insulin resistance and occurs as a postprandial hyperglycaemia. Diabetes mellitus prevalence
increase with increase with age and the elderly could be incidentally diagnosed after 65 years,
at the middle age of later. Different clinical and demographic requirements for the treatment
of diabetes mellitus for different ages causes confusion in the health care setting. Use of less
insulin and lower A1C are characteristic features of age related diabetes especially among the
non-Hispanic whites (Yakaryilmaz & Ozturk, 2017). Selvin, Coresh and Brancati (2006)
think that there is no difference between diabetes mellitus and CVDs prevalence among the

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aging generation. The older people above 75 years old are more vulnerable to contracting
T2DM and other chronic infections as compared to the lower generation.
Overweight, lack of physical activity and obesity are the common causes of T2DM
contributing to about 95 percent of diagnosed diabetes cases in the US (WebMD, 2018). In a
healthy person, the pancreas secretes insulin that helps the body digest and use sugar in the
food ingested. This is not the case for a diabetic person, it is either the pancreas does not
secrete insulin, produces it in little amounts or the body has an impaired response to insulin
(insulin resistance). For people with T2DM, unlike those with T1DM, their pancreas
produces insulin either in small amounts or their bodies do not recognize the insulin secreted
or does not use it appropriately. Glucose in the blood cannot move into body cells but it
accumulate in the blood streams. The body cells are unable to function as required because
they do not get enough glucose.
According to Meneilly and Tessier (2001), there are different risk factors contributing
for the prevalence of T2DM in the older generation. In ethnic groups, genetic factors are the
leading risk factors. Changes in carbohydrate metabolism in the aged, in combination with
genetic factors can be used to explain the increase in type 2 diabetes among the old.
According to the NIDDK (2018), life style and obesity are among the leading risk factors for
diabetes. People who eat diets with high fat concentration, low complex carbohydrates and
are not are not active, are most likely to contract this disease as they approach the old age.
Although uncertain, high levels of testosterone in women and low levels in men appears to be
among the risk factors for diabetes for the old. A research that aimed at evaluating glucose
metabolism in the young generation having type 2 diabetes indicated that there were some
abnormal metabolic characteristics in these patients. They showed high fasting hepatic
glucose secretion, insulin resistance and defects in glucose induced insulin secretion. The
study also assessed obese older patients which showed that hepatic glucose secretion was

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within the required range unlike in the younger generation. The study also showed that the
elderly have a condition found to be between T1DM and T2DM.
In the US, studies show that 8 to 45 percent of diagnosed diabetes cases among the
youth is T2DM. Type two diabetes cases in Japan has outnumbered type 1 diabetes case, with
statistic showing a double increase from 7.3 percent in 1980 to 13.9 percent in 1995 (Alberti,
Zimmet, Shaw, Bloomgardden, Kaufman and Silink, 2004). According to Lascar, Brown,
Pattison, Barnett, Bailey and Bellary (2017), just like in the older generation, prevalence of
type 2 diabetes among the youths is as a result of obesity, sedentary life style and family
history. Its onset is associated with increased chronic complications and disease exposure.
According to Lascar et al. (2017), type 2 diabetes phenotype among the young people is more
aggressive, which causes premature development in the disease complications, affecting the
young people’s quality of life hence making the disease a world public health pandemic.
According to Kesavachandran, Bihari and Muthur (2012), increased type 2 diabetes in the
young generation in the society is a consequence of obesity. They think that the community
and the educational system have failed in educating children and parents on the risk factors of
T2DM and the primary prevention. According to Alberti et al. (2004), girls, according to
research, are more likely to contract T2DM, with 1.7 times more than their male age mates,
though the reason behind this is unknown. There is a need for the government and any
stakeholders to educate the young people on diabetes if the world has to control this disease.
As the prevalence of this disease increases among the youth, there is a likelihood of increased
complications associated with type 2 diabetes such as retinopathy, hypertension and
cardiovascular diseases (Doeke, Hajare and Saoji, 2002).
According to Yakaryilmaz and Ozturk (2017) just like in the young people, the
treatment of diabetes involves hyperglycemia and risk factors. Too much drugs, hypotension
and hypoglycemia should be highly avoided in treatment of diabetes for the elderly.

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Management and treatment of diabetes should be based on the predicted life span and the
health status of the patient. The elderly need counseling on lifestyle changes. They also need
advice on their diets so that they consume low fat diets. Medical therapy for the elderly
diabetic patients, lifestyle changes and metformin are the primary recommendations for
treatment. Patients with comorbid need 3 to 6 months monitoring before starting metformin
therapy. Insulin releasing drugs such as sulfonylureas and meglitinides are also recommended
(Holstein, Hammer, Hahn, Kulamadayil and Kovacs, 2010). Alpha glucosidase inhibitors are
prescribed to inhibit alpha glucosidase enzyme used in the absorption of carbohydrates.
According to Leontis (2018), the best ways to prevent this disease is maintaining a healthy
body weight, increase body activity and eating healthy diet. There has been a slow success in
controlling this disease due to little knowledge on its risk factors and prevention methods
especially in the rural areas. According to Horton (2008), the management of diabetes in the
elderly is facing challenges due to increase in functionality disability and comorbid diseases.
Treatment of type 2 diabetes has to consider both micro and macro vascular complications as
a result of old age and the infection. This makes the treatment and management of diabetes
complex. The diagnosis also has challenges as most of the elderly are not correctly diagnosed
for this condition due to factors like natural increase of renal threshold for glucose as age
advances. Symptoms such as blurred vision, polyuria and fatigue are common in the elderly
as therefore cannot be used in the as a symptom for diabetes.

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References
Aberle, J. H., Stiasny, K., Kundi, M. and Heinz, F. X. (2012). Mechanistic Insight into the
Impairment of Memory B Cells and Antibody Production in the Elderly. The
Springer, Vol. 35, No. 2, pp. 371-381. Doi: https://doi.org/10.1007/s11357-011-9371-
9
Alberti, G., Zimmet, P., Shaw, J., Bloomgarden, Z., Kaufman, F. and Silink, M. (2004). Type
2 Diabetes in the Young: the Evolving Epidemic. The Voice of Women in Diabetes,
Vol. 27, No. 7, pp. 1798-1811. Doi: 10.2337/diacare.27.7.1798.
Deoke A, Hajare S, Saoji A. (2012). Prevalence of overweight in high school students with
special reference to cardiovascular efficiency. Glob J Health Sci. 4:147–52.
Dorrington, M. G. and Bowdish, D. M (2013). Immunosenescence and novel vaccination
strategies for the elderly. Front Immunol. 4:171.
Geiger H., de Haan, G. and Florian M. C. (2013). The ageing haematopoietic stem cell
compartment. Nat Rev Immunol 13:376-389.
Holstein A., Hammer C, Hahn M, Kulamadayil N. S and Kovacs P. (2010). Severe
sulfonylurea-induced hypoglycemia: a problem of uncritical prescription and
deficiencies of diabetes care in geriatric patients. Expert Opin Drug Saf. 9:675–681
Horton, E. S. (2008). Challenges in the Management of Type 2 Diabetes in the Elderly. US
Endocrinology, Vol. 4, No. 1, pp. 47-50. Doi: 10.17925/USE.2008.04.01.47
Kesavachandran CN, Bihari V, Mathur N. (2012). The normal range of body mass index with
high body fat percentage among male residents of Lucknow city in North India.
Journal Family Medicine Primary Care, Vol. 135, pp. 72–77.

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Kirman, S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Haung, E. S.,
Korytkowski, M. T., Munshi, M. N., Odegard, P. S., Pratley, R. E. and Swift, C. S.
(2012). Diabetes in Older Adults. Diabetes Care, Vol. 35, No. 12, pp. 2650-2664. Doi:
10.2337/dc12-1801
Lascar, N., Brown, J., Pattison, H., Barnett, A. H., Bailey, C. J. and Bellary, S. (2017). Type
2 Diabetes in Adolescents and Young Adults. The Lancet, Vol. 6, No. 1, pp. 69-80.
Doi: https://doi.org/10.1016/S2213-8587(17)30186-9
Leontis, L. M. (2018). Type 2 Diabetes Prevention. Retrieved from:
https://www.endocrineweb.com/conditions/type-2-diabetes/type-2-diabetes-
prevention
Montgomery R. R. and Shaw, A. (2015). Paradoxical changes in innate immunity in aging:
recent progress and new directions. J Leukocyte Biol. pii:jlb.5MR0315-104R. [Epub
ahead of print].
Meneilly, G. S and Tessier, D. (2001). Diabetes in Elderly Adults. The Journals of
Gerontology: Series A, Vol. 56, No. 1, pp. M5–M13,
https://doi.org/10.1093/gerona/56.1.M5
Selvin E, Coresh J. and Brancati F. L. (2006). The burden and treatment of diabetes in elderly
individuals in the US. Diabetes Care. 29:2415–2419
The National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Prevention of
Type 2 Diabetes. Retrieved from:
https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-type-2-
diabetes

DIABETES
WebMD. (2018). Causes of type 2 diabetes. Retrieved from:
https://www.webmd.com/diabetes/diabetes-causes#1
Yakaryılmaz, F. D., & Öztürk, Z. A. (2017). Treatment of type 2 diabetes mellitus in the
elderly. World Journal of Diabetes, 8(6), 278–285.
http://doi.org/10.4239/wjd.v8.i6.278
Zhang X., Decker F. H., Luo, H., Geiss, L. S., Pearson, W. S., Saaddine, J. B., Gregg, E. W,
and Albright, A. (2010). Trends in the prevalence and comorbidities of diabetes
mellitus in nursing home residents in the United States: 1995-2004. J Am Geriatr Soc.
58:724–730