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World J Diabetes. Mar 15, 2015; 6(2): 345-351
Published online Mar 15, 2015. doi: 10.4239/wjd.v6.i2.345
Impact of glucose level on morbidity and mortality in elderly with diabetes and pre-diabetes
Orit Twito, Meir Frankel, Dan Nabriski
Orit Twito, Meir Frankel, Dan Nabriski, Endocrinology, Diabetes and Metabolism Institute, Meir Medical Center, Kfar Saba 44281, Israel
Author contributions: Twito O proposed the initial idea of the paper, wrote part of the paper and read and approved the final manuscript; Frankel M wrote part of the paper, and read and approved the final manuscript; Nabriski D made critical revisions, and read and approved the final manuscript.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Orit Twito, Endocrinology, Diabetes and Metabolism Institute, Meir Medical Center, 59 Tschernihovsky, St., Kfar Saba 44281, Israel. orit.twito@clalit.org.il
Telephone: +972-9-7472788 Fax: +972-9-7471644
Received: August 28, 2014
Peer-review started: August 28, 2014
First decision: September 19, 2014
Revised: October 30, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: March 15, 2015
Abstract

The prevalence of type 2 diabetes mellitus (DM) increases with age and reaches 25% in those older than age 65 years. Pre-diabetes status is also very common in the elderly, and is present in about half of those age 75 years and older. Many physicians care for elderly patients with diabetes and pre-diabetes, dealing with the challenge of controlling glucose levels and improving health with minimal adverse events. Over the last decade, research on diabetes among the elderly population has proliferated, adding new information on this topic. This review summarizes the updated medical literature on diabetes and pre-diabetes in the elderly, including the significance of pre-diabetic conditions, new-onset DM in the elderly and long-standing DM. The role of therapeutic intervention and the level of glycemic control for this population are discussed in particular.

Keywords: Diabetes mellitus, Elderly, Old age, Pre-diabetes, Glycemic control

Core tip: The prevalence of diabetes mellitus (DM) and pre-diabetes in old age is very high. However, clinical guidelines do not provide complete information to the clinician managing patients with these conditions. Pre-diabetes status in the elderly increases the risk for DM, but probably does not increase the risk of cardiovascular morbidity and mortality. The role of therapeutic interventions in elderly patients with pre-diabetes is not yet proven. New-onset DM in older age is associated with better glycemic control and better prognosis compared to long standing DM in this population. Nevertheless, higher glucose levels in elderly with new-onset DM are associated with increased all-cause mortality. The benefits of tight glycemic control in elderly with long standing DM are doubtful and may cause more harm than good. To conclude, more research in this field is needed. Currently, the clinical approach for DM and pre-diabetes in the elderly should be tailored to meet individual needs.