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The newspaper of The Johns Hopkins University October 30, 2006 | Vol. 36 No. 9
SPH Study: Diabetes Not Same for All Ages; Treatment Goals May Differ

By Kenna Lowe
Bloomberg School of Public Health

Elderly persons who were diagnosed with diabetes during middle age (40 to 64 years) and those diagnosed later in life (over 65 years) comprise two distinct groups, according to new research from the Johns Hopkins Bloomberg School of Public Health.

The study, published in the November issue of Diabetes Care, found that these two age groups have different disease burdens and may require different treatment goals.

"The number of individuals aged 65 or older in the U.S. is increasing markedly, and diabetes is a growing problem in this population. In addition, people are living to much older ages with high quality of life, which speaks to the need for more aggressive treatment among elderly persons with diabetes," said Elizabeth Selvin, lead author of the study and a postdoctoral fellow in the Bloomberg School's Department of Epidemiology.

The study authors analyzed 1999-2002 data for 2,809 elderly persons in order to present a nationally representative estimate of the prevalence of diabetes among elderly persons in the general U.S. population. The data were taken from the National Health and Nutrition Examination Survey, an ongoing cross-sectional survey of the civilian noninstitutionalized U.S. population.

The authors report that 15 percent of the U.S. population aged 65 years or older had been diagnosed with diabetes, a figure that represents approximately 5.4 million individuals. In addition, 6.9 percent of the U.S. population aged 65 years or older, about 2.4 million individuals, have undiagnosed diabetes and are unaware of their condition.

Elderly persons with middle age-onset diabetes were more likely to have retinopathy, reflecting the cumulative damage of high glucose levels over the course of many years. They also had much worse glycemic control. In contrast, elderly persons with newly diagnosed diabetes had a comparable burden of cardiovascular disease but required less aggressive treatment to reach blood pressure and cholesterol treatment goals.

"The two types of elderly persons with diabetes have distinct characteristics, including different burdens of disease," Selvin said. "Elderly people with diabetes are a heterogeneous group, and doctors may need to consider different treatment goals for these two groups in clinical practice."

The study was co-authored by Selvin, Josef Coresh and Frederick L. Brancati. Selvin was supported by a grant from the National Heart, Lung and Blood Institute.


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