Endocrine Abstracts

The prevalence of diabetes and glucose intolerance is close to 50% in people older than 65. At the same time, near 50% of people with type 2 diabetes are ≥ 65 years old. But being these figures relevant enough to raise a special consideration about how to manage diabetes in this population, there are other reasons supporting the need of that a special consideration. These other needs are not quantitative but qualitative ones, making older people with diabetes a particular group of patents with different characteristics, different aims and, as a consequence, different management compared to adult non-older patients with type 2 patient and, of course, younger patients with both type 1 and type 2 diabetes. These differences range from differences in the pathophysiology of diabetes, that although stemming from insulin resistance have a different origin of this insulin resistance, to the mechanisms underlying the development of vascular and other complications of diabetes, the impact of the disease in the several classical target organs (in people older than 80 diabetes does not increase the risk of blindness), the clinical manifestations of the disease, the diagnostic approach or the general management of the patient. Among all of those, and some others, differences, perhaps the most relevant is the focus on function. While in younger populations, the focus is usually centered in preventing or treating vascular disease (both micro- and macroangiopathy) and other complications of diabetes, when people is older the main focus is to avoid, delay or, if possible, reverse functional (both physical and cognitive) impairment. It is quite clear that diabetes increases less significantly the risk of death in this population, reaching relative risks as low as 1.2 in people older than 80 years. old. However, diabetes is one of the chronic diseases increasing the risk of mobility disability, dependency for instrumental or basic activities of daily living, falls and cognitive impairment/dementia in more than twice. In addition, the role of functional status in conditioning the prognosis (both functional and vital, plus other outcomes like hospitalization) is increasingly higher as patient is getting older, substituting the classical role of the comorbidities (both those related and those non-related to diabetes). Finally, the functional impact of the disease is also the main factor explaining the costs of the disease, reaching figures of 78% of the costs. As a consequence, the management of diabetes in older people should be based in functional status as the main factor in the decision-making process, but also as the main therapeutic target. This change in the focus is crucial to get the best benefits when facing older people with diabetes.