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Diabetes in Older Adults: A Consensus Report
Marian Sue Kirkman, Vanessa Jones Briscoe, Nathaniel G. Clark, Hermes J. Florez, Linda B. Haas, Jeffrey B. Halter, Elbert S. Huang, Mary T. Korytkowski et al.. Journal of the American Geriatrics Society, 2012-10-25
Topic: Health services, long-term care and technology
More than 25% of the U.S. population aged ≥ 65 years has diabetes mellitus (hereafter referred to as diabetes),1 and the aging of the overall population is a significant driver of the diabetes epidemic. Although the burden of diabetes is often described in terms of its impact on working-age adults, diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of institutionalization.2 Older adults with diabetes are at substantial risk for both acute and chronic microvascular and cardiovascular complications of the disease. Postprandial hyperglycemia is a prominent characteristic of type 2 diabetes in older adults,3, 4 contributing to observed differences in prevalence depending on which diagnostic test is used.5 Using the hemoglobin A1C (A1C) or fasting plasma glucose (FPG) diagnostic criteria, as is currently done for national surveillance, one-third of older adults with diabetes are undiagnosed.1 The epidemic of type 2 diabetes is clearly linked to increasing rates of overweight and obesity in the U.S. population, but projections by the Centers for Disease Control and Prevention (CDC) suggest that even if diabetes incidence rates level off, the prevalence of diabetes will double in the next 20 years, in part due to the aging of the population.5 Other projections suggest that the number of cases of diagnosed diabetes in those aged ≥ 65 years will increase by 4.5-fold (compared to 3-fold in the total population) between 2005 and 2050.6 The incidence of diabetes increases with age until about age 65 years, after which both incidence and prevalence seem to level off (www.cdc.gov/diabetes/statistics). As a result, older adults with diabetes may either have incident disease (diagnosed at and after age 65 years) or long-standing diabetes with onset in middle age or earlier. Although a history of retinopathy is significantly more common in older adults with middle-age–onset diabetes than those with older-age onset, there is, interestingly, no difference in prevalence of cardiovascular disease (CVD) or peripheral neuropathy by age of onset.7 Older adults with diabetes have the highest rates of major lower-extremity amputation,8 myocardial infarction (MI), visual impairment, and end-stage renal disease of any age-group. Deaths from hyperglycemic crises also are significantly higher in older adults (although rates have declined markedly in the past 2 decades). Age-related insulin resistance appears to be primarily associated
Key findings
- More than 25% of the U.S. population aged ≥ 65 years has diabetes mellitus (hereafter referred to as diabetes),1 and the aging of the overall population is a significant driver of the diabetes epidemic.
- Although the burden of diabetes is often described in terms of its impact on working-age adults, diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of institutionalization.2 Older adults with diabetes are at substantial risk for both acute and chronic microvascular and cardiovascular complications of the disease.
- Postprandial hyperglycemia is a prominent characteristic of type 2 diabetes in older adults,3, 4 contributing to observed differences in prevalence depending on which diagnostic test is used.5 Using the hemoglobin A1C (A1C) or fasting plasma glucose (FPG) diagnostic criteria, as is currently done for national surveillance, one-third of older adults with diabetes are undiagnosed.1 The epidemic of type 2 diabetes is clearly linked to increasing rates of overweight and obesity in the U.S. population, but projections by the Centers for Disease Control and Prevention (CDC) suggest that even if diabetes incidence rates level off, the prevalence of diabetes will double in the next 20 years, in part due to the aging of the population.5 Other projections suggest that the number of cases of diagnosed diabetes in those aged ≥ 65 years will increase by 4.5-fold (compared to 3-fold in the total population) between 2005 and 2050.6 The incidence of diabetes increases with age until about age 65 years, after which both incidence and prevalence seem to level off (www.cdc.gov/diabetes/statistics).
- As a result, older adults with diabetes may either have incident disease (diagnosed at and after age 65 years) or long-standing diabetes with onset in middle age or earlier.
- Although a history of retinopathy is significantly more common in older adults with middle-age–onset diabetes than those with older-age onset, there is, interestingly, no difference in prevalence of cardiovascular disease (CVD) or peripheral neuropathy by age of onset.7 Older adults with diabetes have the highest rates of major lower-extremity amputation,8 myocardial infarction (MI), visual impairment, and end-stage renal disease of any age-group.
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Study details
- Study designmeta-analysis
- Participants1,000
- Effect size6.5%; 7.5%; 6.0%
- Evidence strengthHigh
How this study scored 81/100
Published in a peer-reviewed journal, and it is a meta-analysis pooling many studies. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 47 of the 58 points we could judge it on, which is 81 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 12 / 12 | A meta-analysis pooling many studies |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2012 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,000 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 23106132) |
| Free to read | 2 / 2 | Free to read |
| Points | 47 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 47 of the 58 points we could judge it on is 81 out of 100. |
| Total | 81 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Kirkman, M. S., Briscoe, V. J., Clark, N. G., Florez, H. J., Haas, L. B., Halter, J. B., et al. (2012). Diabetes in Older Adults: A Consensus Report. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.12035
Vancouver
Kirkman MS, Briscoe VJ, Clark NG, Florez HJ, Haas LB, Halter JB, et al. Diabetes in Older Adults: A Consensus Report. Journal of the American Geriatrics Society. 2012. doi:10.1111/jgs.12035. PMID: 23106132.
BibTeX
@article{kirkman2012-23106132,
author = {Kirkman, Marian Sue and Briscoe, Vanessa Jones and Clark, Nathaniel G. and Florez, Hermes J. and Haas, Linda B. and Halter, Jeffrey B. and Huang, Elbert S. and Korytkowski, Mary T. and others},
title = {{Diabetes in Older Adults: A Consensus Report}},
journal = {Journal of the American Geriatrics Society},
year = {2012},
doi = {10.1111/jgs.12035},
pmid = {23106132},
url = {https://doi.org/10.1111/jgs.12035}
}
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