Diabetes May Affect Young and Old Differently

Diabetes duration and age diagnosed may cause different vascular complications

(RxWiki News) Diabetes affects millions in the US. But new research suggests that it may affect patients in different ways.

Diabetes can lead to a number of complications, such as narrowing blood vessels and vision loss.

Looking at how diabetes patients' health changed over time, a recent study found that risk of death from narrowing arteries was a more pressing concern for older patients. Younger people with the disease had a greater risk of diabetic vision loss.

"Seek medical care for diabetes or high blood sugar."

Sophia Zoungas, MD, PhD, of the George Institute for Global Health at the University of Sydney in Australia, and colleagues studied the effects of age and diabetes duration on patients' risk of death and vascular complications.

Diabetes occurs when blood sugar levels are too high. That happens when the body either doesn’t make the hormone insulin (type 1) or doesn’t respond to it (type 2).

Macrovascular complications can affect large blood vessels by narrowing arteries. Microvascular diabetes complications affect small blood vessels, like those in the eye, and can lead to vision problems.

The authors studied 11,140 patients with type 2 diabetes. Their average age was 66, and they were all older than 55. On average, they were 59 when they were diagnosed with diabetes.

For each five-year increase in age, the risk of macrovascular complications increased 33 percent. The risk of death went up by 56 percent.

For each five-year increase in how long a patient had diabetes, the risk of macrovascular complication went up by 13 percent. The risk of death increased by 15 percent.

In response to the findings, the authors said “prevention requires vigilance at all stages of the disease and across all age groups. Surveillance for macrovascular complications should be intensified with increasing age.”

For each five-year increase in diabetes duration, the risk of microvascular complications increased by 28 percent.

The authors wrote that effects of diabetes duration “are greatest at younger rather than older ages." That's because a person who gets diabetes at a younger age will likely live longer with the disease than an elderly person.

The authors recommended intense blood sugar control in young people to reduce the risk of diabetic vision loss.

"The overall goal for the treatment of diabetes in all ages is achieving blood sugar targets and reducing the risk of diabetic complications," said Tenesha R. Chappell, MD, an internal medicine physician on the medical staff of Baylor Medical Center at Irving.

"Diabetes control should be tailored to the individual," said Dr. Chappell, who was not involved in this study. "Some older individuals, such as those that are frail and have multiple medical problems, do not benefit from aggressive blood sugar control. Strict blood sugar control in this population results in higher rates of hypoglycemia (low blood sugars). Low blood sugars can lead to higher rates of falls and confusion in older individuals. Thus, target blood sugars should be higher in older frail adults with multiple comorbidities. More stringent blood sugar control is recommended for those with type 1 diabetes, which includes younger patients."

Dr. Chappell offered her recommendations on how to lower the risk of diabetes-related complications.

"Follow a healthy diet low in sugars and carbohydrates with the help of your doctor, diabetes educator and/or dietitian," she said. "Exercise regularly and maintain a healthy weight. Monitor your blood sugars and keep your blood sugars within your target range. Avoid smoking. Maintain a normal blood pressure and cholesterol levels. Have eye exams at least yearly. See your doctor at least every three months for diabetes checkups."

The study by Dr. Zoungas and team was published online Sept. 11 in Diabetologia.

The National Health and Medical Research Council of Australia and Servier, a pharmaceutical company, funded the research. Some of the authors received lecture fees and grants from Servier.

Review Date: 
September 10, 2014