Type 2 diabetes in older patients: an analysis of the DPV and DIVE databases

Abstract

Background: The clinical profile differs between old and young patients with type 2 diabetes mellitus (T2DM). We explored, based on a large real-world database, patient and disease characteristics and actual treatment patterns by age. Methods: The analysis was based on the DIVE and DPV registries of patients with T2DM. Patients were analyzed by age groups 50–59 (middle-young), 60–69 (young-old), 70–79 (middle-old), 80–89 (old), and 90 years or more (oldest-old). Results: A total of 396,719 patients were analyzed, of which 17.7% were 50–59 years, 27.7% 60–69 years, 34.3% 70–79 years, 18.3% 80–89 years and 2.0% at least 90 years. We found that (a) T2DM in old and oldest-old patients was characterized much less by the presence of metabolic risk factors such as hypertension, obesity, dyslipidemia and smoking than in younger patients; (b) the HbA1c was much lower in oldest-old than in middle-young patients (7.2 ± 1.6% versus 8.0 ± 2.2%; p < 0.001), but it was associated with higher proportions of patients with severe hypoglycemia (7.0 versus 1.6%; p < 0.001); (c) this was potentially associated with the higher and increasing rates of insulin use in older patients (from 17.6% to 37.6%, p < 0.001) and the particular comorbidity profile of these patients, for example, chronic kidney disease (CKD); (d) patients with late diabetes onset had lower HbA1c values, lower bodyweight and less cardiovascular risk factors; (e) patients with a longer diabetes duration had a considerable increase in macrovascular and even more microvascular complications. Conclusion: In very old patients there is a need for frequent careful routine assessment and a tailored pharmacotherapy in which patient safety is much more important than blood-glucose-lowering efficacy.

Incidence and risk factors of diabetes mellitus in the Chinese population: a dynamic cohort study

“…[3][4][5] Diabetes mellitus is a common condition associated with ageing. [6][7][8][9][10] It is predicted that the incidence of diabetes will continue to increase over the next 20 years, with the majority of patients aged between 45 and 64 years. 11 The number of older people with diabetes worldwide was estimated to be 135.6 million and was expected to rise to 276.2 million by 2045.…”

“…Rapid ageing has resulted in an increased burden on healthcare, owing to age-related diseases 3–5. Diabetes mellitus is a common condition associated with ageing 6–10. It is predicted that the incidence of diabetes will continue to increase over the next 20 years, with the majority of patients aged between 45 and 64 years 11.…”

DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus

“… 26 In line with this, we observed in this insulin-treated population a higher proportion of microvascular disease (85.3% vs 83.6%) compared with our previous DIVE/DPV analysis (also including insulin-naïve subjects), which revealed proportions from 59.8% of patients aged 70–79 years old to 50.4% of those aged >90 years. 2 …”

Disease heterogeneity of adult diabetes based on routine clinical variables at diagnosis: Results from the German/Austrian Diabetes Follow‐up Registry

“…Hypertension was defined as systolic blood pressure of 140 mmHg or higher and/or diastolic blood pressure of 90 mmHg or higher and/or antihypertensive treatment. (11) Hyperuricaemia was defined as uric acid of more than 6 and of more than 7 mg/dl in females and males, respectively, (12) and 'components of metabolic syndrome' was defined as having at least one of dyslipidaemia, hypertension or hyperuricaemia. In addition, we present '≥3 components of metabolic syndrome' (dyslipidaemia, hypertension, hyperuricaemia, carbohydrate metabolism disorder, obesity [BMI > 30 kg/m 2 ]).…”