Diabetes and altered glucose metabolism with aging

Abstract

Diabetes and impaired glucose tolerance affect a substantial proportion of older adults. Abnormal glucose metabolism is not a necessary component of aging. Older adults with diabetes and altered glucose status likely represent a subset of the population at high risk for complications and adverse geriatric syndromes. Goals for treatment of diabetes in the elderly include control of hyperglycemia, prevention and treatment of diabetic complications, avoidance of hypoglycemia, and preservation of quality of life. Research exploring associations of dysglycemia and insulin resistance with the development of adverse outcomes in the elderly may ultimately inform use of future glucose-lowering therapies in this population.

Figure 1. Diabetes and the Pathway to Disability

Figure 1 depicts proposed associations of diabetes with each step in the pathway to disability. Accelerated loss of muscle mass and strength, particularly in the lower extremities, may lead to functional limitations in routine tasks of daily living which may ultimately result in physical disability among older persons with diabetes. Frailty is a geriatric syndrome that encompasses the full spectrum of the disability process and is also more common with impaired glucose states and diabetes.

Figure 2. Sites of Action for Common Glucose-Lowering Therapies

Figure 2 demonstrates the sites of action for common glucose-lowering therapies used in persons with type 2 diabetes. The different mechanisms by which these drugs improve blood glucose, along with potential benefits and side effects, are important considerations in the management of the older patient with diabetes. Exercise, particularly muscle-strengthening or resistance activities, can have additional benefits on glucose uptake by skeletal muscle.