TUESDAY, Dec. 10, 2013 (HealthDay News) -- Better diabetes
treatment has slashed rates of complications such as heart attacks,
strokes and amputations in older adults, a new study shows.
"All the event rates, if you look at them, everything is a lot
better than it was in the 1990s, dramatically better," said study
author Dr. Elbert Huang, an associate professor of medicine at the
University of Chicago.
The study also found that hypoglycemia, or low blood sugar -- a
side effect of medications that control diabetes -- has become one
of the top problems seen in seniors, suggesting that doctors may
need to rethink drug regimens as patients age.
The findings, published online Dec. 9 in
JAMA Internal Medicine, are based on more than 72,000 adults
aged 60 and older with type 2 diabetes. They are being tracked
through the Kaiser Permanente Northern California Diabetes
Researchers tallied diabetic complications by age and length of
time with the disease.
People with type 2 diabetes, the most common form of the
disease, have too much sugar in the blood. It's estimated that
roughly 23 million people have type 2 diabetes in the United
States, about half of them older than 60. Many more are expected to
develop diabetes in coming years.
In general, complications of diabetes tended to worsen as people
got older, the study found. They were also more severe in people
who'd lived with the disease longer.
Heart disease was the chief complication seen in seniors who'd
lived with the disease for less than 10 years. For every 1,000
seniors followed for a year, there were about eight cases of heart
disease diagnosed in those under age 70, about 11 cases in those in
their 70s, and roughly 15 cases for those aged 80 and older.
Among those aged 80 or older who'd had diabetes for more than a
decade, there were 24 cases of heart disease for every 1,000 people
who were followed for a year.
That's a big drop from just a decade ago, when a prior study
found rates of heart disease in elderly diabetics to be about seven
times higher -- 182 cases for every 1,000 people followed for a
Heart disease isn't the only complication to see drastic
declines. Dangerous episodes of high blood sugar have plunged about
10-fold since 2002, while amputations appear to be about three
Things are so much better, in fact, that it's the treatment
itself that's now become one of the major reasons seniors with
diabetes get sick.
Hypoglycemia due to plummeting blood sugar -- characterized by
weakness, heart palpitations, trembling, sweating, trouble speaking
and anxiety -- is now the third most common nonfatal complication
of diabetes in long-term diabetics aged 70 and older, the
"Hypoglycemia is a side effect of therapy and it's not a good
thing," Huang said. "It's now more common than [kidney] failure or
amputation. That means the side effects of treatment are now more
common than the things we're trying to prevent," he said.
An expert who wasn't involved with the study praised its focus
on older adults, who make up about half of those living with
diabetes in the United States.
"We are getting more and more concerned about the complications
that occur in older adults with ongoing treatment," said Dr. Gisele
Wolf-Klein, director of geriatric education at the North Shore-LIJ
Health System in New Hyde Park, N.Y.
Wolf-Klein, who has studied rates of hypoglycemia in nursing
home residents, says it's an underappreciated problem.
"We need to understand that older diabetics may be continuing to
take the same medication they always took, but they've completely
changed their lifestyle," said Wolf-Klein.
For example, many seniors struggle to get enough to eat during
the day, something doctors may not think to ask about. Metabolism
also slows with age, Wolf-Klein said, making drugs that lower blood
sugar especially potent in this population.
"We have to remember that because people are living much longer,
the way you treat diabetes in a 40-year-old is going to be very
different than the way you treat diabetes in an older patient," she
For more information on hypoglycemia, visit the
American Diabetes Association.