Diabetes and Cardiovascular Disease in Older Adults: Current Status and Future Directions

Jeffrey B. Halter; Nicolas Musi; Frances McFarland Horne; Jill P. Crandall; Andrew Goldberg; Lawrence Harkless; William R. Hazzard; Elbert S. Huang; M. Sue Kirkman; Jorge Plutzky; Kenneth E. Schmader; Susan Zieman; Kevin P. High


Diabetes. 2014;63(8):2578-2589. 

In This Article

Future Research Directions

The convergence of pathways underlying diabetes and CVD on inflammation and oxidative stress suggests that these age-related diseases might arise from a common foundation. An overarching research question then is how various mechanisms contributing to diabetes and CVD affect and are affected by advancing age. Many other potential research directions, including specific questions listed in Table 3, also should be explored. In the past, research has often examined pathways, organs, and systems independently. However, optimal health relies on a balance of interrelated systems, and age or diabetes may shift that balance. The mechanisms underlying the cardiovascular, renal, nerve, and cognitive complications of diabetes suggest a common microvascular pathway. More research is needed on interactions between vascular and cognitive abnormalities and on signaling between the cardiovascular system and the brain. Increased understanding of the pathways common to diabetes, CVD, and other morbidities might yield optimal treatments for diabetes and its complications. More multidisciplinary or interdisciplinary studies are needed.

Animal models of aging are needed to explore many of these questions, keeping in mind that differences between organisms can hamper the translation of observations. Likewise, clinical trial populations are highly selected and have largely excluded older individuals with diabetes so that results are not generalizable to patients in everyday practice. Improved predictive models, including those that account for patient heterogeneity and can be used in real practice, are needed for clinical trial participant selection. Finally, intervention development has suffered because epidemiologically powerful associations have not necessarily been borne out in intervention trials. While clinical end points and mortality remain important, future studies also should include end points, such as functional outcomes, that are of particular interest to older adults. Thus, geriatricians should be involved in clinical trial design and in achieving consensus on the best measures and scales for assessment.