Diabetes and Cardiovascular Disease Among Older Adults: An Update on the Evidence

Pamela Katz, MD; Jeremy Gilbert, MD, FRCPC

Disclosures

Geriatrics and Aging. 2008;11(9):509-514. 

In This Article

Abstract and Introduction

Abstract

The global prevalence of diabetes has increased substantially in recent years, attributable to an increase in new cases and declining mortality. Aging is associated with changes in beta cell function and insulin resistance that predispose to diabetes. Cardiovascular disease is the leading cause of death among older adults with diabetes. In order to reduce the excessive risk of cardiovascular disease, all coronary risk factors must be addressed and treated aggressively. This article will focus on the importance of blood pressure and glycemic control and lipid lowering with statin therapy. Specific considerations in this patient population include high rates of comorbid disease, shorter life expectancy, polypharmacy and falls risk. These factors may alter the therapeutic goals. Treatment should therefore be individualized with consideration given to patient preference and quality of life.

Introduction

The global prevalence of diabetes is rising, attributable to an increase in new cases driven by obesity rates and the aging population, and declining mortality.[1] While the prevalence is highest in developed countries, the rise in diabetes rates is greatest in the developing nations.[1] Aging is associated with declining beta cell function, lower blood insulin levels, and increased insulin resistance.[2] One in seven Canadians is over the age of 65 and the proportion of older adults is expected to nearly double over the next 25 years.[3] As the largest segment of our population ages, rates of diabetes are expected to continue rising. From 1995 to 2005, there was a 69% increase in the prevalence of diabetes in Ontario.[1] It is now projected that by 2010, 10% of the adult population in Ontario will be diagnosed with diabetes and the majority of those will be over 50 years of age.[1]

The older adult population is heterogeneous with wide variations in functional status, comorbidities, and life expectancy. In this article, we highlight the results of studies that included individuals over the age of 65, acknowledging that frail older adults and those at extremes of age are often excluded. Management of diabetes in these persons requires an individualized approach with attention to unique geriatric considerations including cognitive impairment, polypharmacy, and falls risk. Treatment strategies should take into account these factors, as well as quality of life and patient preference.

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