Diabetes and the Effects of Aging
Make it a priority to get screened because diabetes and prediabetes impact nearly half of all Americans, many of them older
The American Diabetes Association (ADA) reports that 133 million Americans have diabetes or prediabetes: 37 million have diabetes, and 96 million have prediabetes.
Anish J. Patel, MD, assistant professor of medicine in the Division of Endocrinology, Diabetes and Metabolism at the University of Alabama at Birmingham Hospital, reports that diabetes increases with age. "Where 14.5% of people between the ages of 45 and 64 have diabetes, 24.4% of people above 65 have it," Patel says.
Steve LeVine, 52, of Brooklyn, New York, was diagnosed with Type 2 Diabetes at age 44 when he visited his doctor for a cold and flu. When LeVine reported increased thirst, increased water intake and frequent urination, his doctor ordered blood and urine tests, revealing diabetes.
Older adults with diabetes often have coexisting conditions like hypertension, heart disease and kidney disease.
His doctor prescribed medication and advised LeVine to decrease his sugar intake and increase his exercise level.
As we age, we can become less active and more sedentary. "This, coupled with a relatively unchanged diet, can lead to weight gain and insulin resistance which increases the risk for diabetes," Patel notes.
In addition, long-term inactivity may also contribute to developing diabetes. As Francisco Prieto, MD, the ADA's National Advocacy Chair, explains, "Many people gain weight over time, and in particular fat around our middles (visceral fat) affects our metabolism in ways that promote diabetes."
Insulin resistance can also contribute to the onset of diabetes. "Insulin resistance means the body becomes resistant to the effects of insulin, an essential hormone necessary for life," Prieto says. Insulin is a chemical "key" that allows glucose to enter cells so they can function.
"When a person starts on the path towards type 2 diabetes, the body tries to compensate by producing more and more insulin, and for a while, it can keep up. However, when it can't, glucose starts to build up and rise in the bloodstream, creating toxic effects that lead to many of the worse complications of diabetes," Prieto explains.
"Eventually the pancreas can't keep up, starts to wear out (leading to impaired pancreatic islet function), and insulin production starts to fail, ultimately reaching the point where they must take supplemental insulin," he says.
The Effects of Aging
As we age, we are at increased risk for other chronic conditions, and older people with diabetes often have coexisting conditions like hypertension, heart disease and kidney disease.
"People with diabetes who develop cognitive impairment or dementia and who require insulin or other medications that can cause low blood sugar are at especially high risk," Prieto says.
"Medications used to treat some other medical conditions including some meds used to treat HIV, in organ transplants, some mental health conditions and others can also predispose those patients to develop diabetes," he adds.
"Hormonal changes as we age, like menopause for women and slow decline in testosterone among men, can also contribute to how the body metabolizes energy sources like fats, sugars and proteins," Patel explains.
It's essential to get screened because, many times, diabetes can be present without symptoms, and you can be unaware that you have prediabetes or diabetes. The ADA recommends getting screened at age 35 and earlier if you are overweight or obese or have a family history of diabetes.
Patel notes that compared to White Non-Hispanic populations, Hispanic, Asian and Black people tend to have a higher prevalence of diabetes. Therefore, he recommends screening patients with a BMI (Body Mass Index) of over 25 (or more than 23 for Asian Americans).
Patients with a history of diabetes during pregnancy and those with cholesterol issues, heart disease or high blood pressure should be screened for diabetes. If a patient is over 35, even if they filter negative for diabetes, they should be tested every three years.
How Lifestyle Changes Can Have Impact
"Dietary change is probably the largest factor that people's choices can directly influence," Patel says, "though it is not always the easiest and can be limited by multiple factors such as finances or access to healthy foods."
But, he adds, "one change that is accessible to most people is cutting out sugar-sweetened beverages common in the U.S. diet," like sweet tea, soda, juices and sugary coffee drinks.
"Being diagnosed is a good thing — especially if you've ignored symptoms for years."
"This can make a large difference in the number of calories one ingests in a day, while also significantly cutting down on carbohydrates," Patel says, suggesting replacing these drinks with water.
The Future of Diabetes Treatment
Patel notes that recent incretin therapies are increasing in use to treat diabetes, like semaglutide (Ozempic), dulaglutide (Tulicity) and tirzapitide (Mounjaro). "These agents work in several different ways to help with blood sugar control with the added benefits of weight loss and some cardioprotective effects," he explains.
Other technological advancements include insulin pumps and continuous glucose monitoring, which Patel says is "creeping closer towards achieving an artificial pancreas."
Seek a Doctor's Advice
"If there's even the slightest suspicion of symptoms, it's so easy to have a doctor do a blood and urine test," LeVine advises.
"If you've been diagnosed and trust your doctor, listen to their advice. If not, find a doctor or specialist and listen to them. Being diagnosed is a good thing – especially if you've ignored symptoms for years," he adds.
- Get regular exercise (150 minutes per week)
- Make a healthy eating plan
- Manage your weight
- Take care of your mental health
- Take your medications and recommended treatment
- For more information, visit the American Diabetes Association resource page for older adults.