The burden and treatment of diabetes in elderly individuals in the US

OBJECTIVE - To assess the prevalence of diabetes, distinguishing between elderly individuals with diabetes diagnosed in middle age (middle age-onset diabetes) from elderly individuals with recently diagnosed diabetes (elderly onset diabetes) and to assess the burden of complications and control of cardiovascular risk factors in these groups. RESEARCH DESIGN AND METHODS - We analyzed data from 2,809 elderly individuals from the 1999-2002 National Health and Nutrition Examination Survey, a cross-sectional nationally representative survey of the civilian noninstitutionalized population of the U.S. RESULTS - Among adults aged >= 65 years, the prevalence of diagnosed diabetes was 15.3%, representing 5.4 million individuals in the U.S. The prevalence of undiagnosed diabetes was 6.9% or 2.4 million individuals. Elderly individuals with middle age-onset diabetes had a much greater burden of microvascular disease but have a similar burden of macrovascular disease compared with individuals with elderly onset diabetes. Elderly individuals with middle age-onset diabetes had substantially worse glycemic control (proportion of individuals with HbA(1c) > 7% = 59.9%) compared with either elderly onset (41.6%), or nonelderly individuals with diabetes (55.3%). Individuals with elderly onset diabetes were also less likely to be taking glucose-lowering medications. CONCLUSIONS - In this study, we documented a high prevalence of diabetes among elderly individuals and high rate of poor glycemic control in this population. Individuals with middle age- and elderly onset diabetes appear to represent distinct groups with differing burdens of disease and possibly differing treatment goals. Future studies of diabetes in elderly individuals may need to consider stratification based on age of diagnosis.