Diabetes in the elderly: diagnosis, pathogenesis, and therapy.

The prevalence of diabetes mellitus increases with age; it occurs in approximately 10 percent of Americans 60 years of age and in 16 to 20 percent of those 80 years old. Type II diabetes mellitus is primarily found in the elderly, and it is estimated that an additional 20 percent of the elderly population has age-associated hyperglycemia, which may be part of a spectrum between normality and type II diabetes. The diabetic group is at risk for both microvascular and macrovascular complications of diabetes, whereas the group with the hyperglycemia of aging may be at risk for macrovascular-type complications. Thus, 40 percent of our senior population has abnormal carbohydrate tolerance and is at risk for diabetic-type chronic complications. The basis for both the diabetic state as well as for the hyperglycemia of aging is probably multifactorial--involving both altered insulin secretion and altered insulin action. Unique problems arise in treating older diabetic patients. Physiologic changes occurring during normal aging, age-associated pathologic processes, the increased prevalence of other chronic diseases, and polypharmacy must all be considered in selecting appropriate therapy for these patients. A rational approach for the maintenance of glucose homeostasis is presented for older patients with diabetes.